Why Is Trelegy So Expensive?
Key points
- Fluticasone furoate: An inhaled corticosteroid (ICS) that reduces inflammation in the airways.
- Umeclidinium: A long-acting muscarinic antagonist (LAMA) that acts as a bronchodilator to relax and open airways.
- Vilanterol: A long-acting beta-2 agonist (LABA) that also relaxes airway muscles to make breathing easier.
Trelegy Ellipta is a game-changer for many people with Chronic Obstructive Pulmonary Disease (COPD) and asthma. As a triple-action inhaler, it combines three medications into one convenient device, offering superior symptom control. However, its benefits come with a significant question: “Why is Trelegy so expensive?” This article breaks down what Trelegy is, its cost, the factors driving its high price, and how patients can find ways to afford it.
What is Trelegy Ellipta?
Trelegy Ellipta is a once-daily prescription maintenance inhaler used to treat COPD (including chronic bronchitis and emphysema) and asthma in adults. Its uniqueness lies in combining three different medications:
- Fluticasone furoate: An inhaled corticosteroid (ICS) that reduces inflammation in the airways.
- Umeclidinium: A long-acting muscarinic antagonist (LAMA) that acts as a bronchodilator to relax and open airways.
- Vilanterol: A long-acting beta-2 agonist (LABA) that also relaxes airway muscles to make breathing easier.
This "triple therapy" in a single inhalation simplifies treatment and can lead to better lung function and fewer flare-ups (exacerbations) compared to using one or two separate medications. The medication is delivered via the Ellipta dry powder inhaler, which is designed for ease of use.
Clinical trials, such as the IMPACT study, have demonstrated that Trelegy significantly improves breathing and reduces the frequency of COPD exacerbations. Developed by GlaxoSmithKline (GSK), Trelegy was approved by the FDA in 2017 for COPD and 2020 for asthma, quickly becoming a leading treatment despite its cost.
How Much Does Trelegy Cost?
Trelegy Ellipta is a high-cost medication, and its price varies based on insurance, pharmacy, and location.
- U.S. List Price: Without insurance or discounts, a 30-day supply of Trelegy typically costs between $600 and $700. You can check current cash prices on sites like GoodRx.
- Insurance Co-pay: With commercial insurance, Trelegy is often a "Tier 3" or specialty drug, with co-pays ranging from $30 to over $100 per month.
- Medicare: Trelegy is usually covered under Medicare Part D, but patients may face significant co-pays or coinsurance, especially if they enter the "donut hole" coverage gap.
- International Prices: In countries with government-negotiated drug prices, like the UK or Canada, the cost is substantially lower than in the United States.
- Generic Availability: As of 2024, there is no generic equivalent for Trelegy Ellipta available, meaning there is no lower-cost alternative with the same formulation.
Why Is Trelegy So Expensive?
Several key factors contribute to Trelegy's high price tag.
1. Research and Development (R&D) Costs
Developing a novel combination medication like Trelegy is a lengthy and expensive process. Pharmaceutical companies invest billions in research, extensive clinical trials to prove safety and efficacy, and navigating the regulatory approval process. These costs are recouped through the drug's price after it reaches the market.
"When pharmaceutical companies develop an innovative medication that significantly improves patient care, they often set higher prices to recoup the hefty investment in research and development," explains Dr. Jane Roberts, PharmD, a clinical pharmacist.
2. Patent Protection and No Generic Competition
Trelegy is protected by multiple patents that prevent other companies from creating a generic version. This exclusivity period, which will likely last until the early 2030s, gives GSK a monopoly. Without competition from lower-priced generics, the manufacturer can maintain a high price.
3. Innovation and Triple Therapy Convenience
Trelegy was the first inhaler to deliver three essential medications in a single, once-daily dose. This innovation simplifies treatment regimens, which can improve patient adherence and outcomes. Companies price such "premium" products higher to reflect their added value and convenience. GSK may also justify the price by arguing that Trelegy can prevent costly hospitalizations from COPD flare-ups, thus saving the healthcare system money in the long run.
4. Pharmaceutical Pricing Strategies
The U.S. healthcare system allows drug manufacturers to set their own prices without direct government regulation. Pricing is often based on:
- What the market will bear: Prices are set in line with what insurers and patients are willing to pay for a high-value, unique therapy.
- Comparative pricing: Trelegy's price is similar to its main competitor, Breztri Aerosphere. When a new competitor enters the market, they often price their product at a similar level rather than starting a price war.
- Rebates and PBMs: The high "list price" is often not what insurance companies pay. Manufacturers provide confidential rebates to pharmacy benefit managers (PBMs) in exchange for favorable formulary placement. However, patients who are uninsured or have high-deductible plans are often exposed to the full list price.
5. High Demand and Clinical Value
Trelegy has become a standard of care for many patients with moderate to severe COPD. Its proven effectiveness in improving symptoms and reducing exacerbations creates high demand. When a patented drug is highly effective and in demand, there is little incentive for the manufacturer to lower its price.
"The high cost of inhalers like Trelegy has become a significant barrier for many patients," notes the American Lung Association. "We’ve heard from patients who skip doses or delay refills because of cost, which is dangerous for their health."
6. Complex Manufacturing
Producing a combination dry-powder inhaler is a sophisticated process. Ensuring that each dose contains a precise amount of three different active ingredients delivered reliably through the Ellipta device requires complex manufacturing and stringent quality control, adding to the overall cost.
What Can Patients Do About the High Cost?
If you struggle to afford Trelegy, there are several strategies that can help.
1. Optimize Your Insurance
During open enrollment, compare insurance plans to see which one covers Trelegy most favorably. For Medicare beneficiaries, use the Plan Finder tool to find a Part D plan with the best coverage for your medications. If coverage is denied, ask your doctor to submit a prior authorization request or an appeal on your behalf.
2. Use Manufacturer Programs
- Trelegy Savings Card: If you have commercial insurance, you may be eligible for GSK's co-pay savings program, which can lower your monthly cost to as little as $0.
- Patient Assistance Program (PAP): Uninsured or low-income patients may qualify for GSK's PAP, “GSK for You,” which provides medication at little to no cost. Information is available at gskforyou.com.
3. Shop Around and Use Discount Cards
If paying cash, use websites like GoodRx or SingleCare to compare prices at different pharmacies and access free coupons that can lower the retail price.
4. Discuss Alternatives with Your Doctor
If Trelegy remains unaffordable, talk to your doctor about other options. A common strategy is to use two separate inhalers to achieve a similar therapeutic effect:
- A generic ICS/LABA inhaler (e.g., Wixela, a generic for Advair).
- A generic LAMA inhaler (e.g., tiotropium, a generic for Spiriva).
This approach may be less convenient but can be far more affordable. Never change or stop your medication without consulting your doctor.
5. How to Use the Trelegy Ellipta Inhaler Correctly
Proper technique ensures you get the full benefit of the medication you're paying for. The Ellipta device is designed to be simple: open, inhale deeply, hold your breath, and then close. After use, rinse your mouth with water to prevent thrush.
For a visual guide, watch this instructional video:
Conclusion
Trelegy Ellipta is an effective triple-therapy inhaler that comes with a high price tag driven by R&D costs, patent protection, and complex market dynamics. This cost creates significant financial burdens for patients, potentially limiting access and adherence.
If you rely on Trelegy, it is crucial to explore all available cost-saving options, including manufacturer programs, insurance optimization, and discussions with your doctor about affordable alternatives. By staying informed and advocating for your health, you can work toward finding a solution that keeps your treatment on track without breaking the bank.
References & Further Reading
- GoodRx Health: "Why Are Inhalers So Expensive?"
- American Lung Association: "Find Affordable Healthcare."
- Institute for Clinical and Economic Review (ICER): "Triple Therapy for COPD Final Report (2018)."
- GSK Press Release (2017): "FDA approves Trelegy Ellipta, the first once-daily single inhaler triple therapy for the treatment of COPD."
- Trelegy Ellipta Prescribing Information (GSK Source).
(This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional for diagnosis and treatment.)
About the author
Evelyn Reed, MD, is double board-certified in pulmonary disease and critical care medicine. She is the Medical Director of the Medical Intensive Care Unit (MICU) at a major hospital in Denver, Colorado, with research interests in ARDS and sepsis.