Medication Adherence in COPD: Cost Barriers and Strategies for Affordability on Fixed Incomes
Key Insights
Medication nonadherence due to cost affects up to 19% of COPD (search) patients, worsening symptoms and accelerating lung function decline.
Newer COPD (search) therapies including biologics like dupilumab and mepolizumab, and inhaled agents like ensifentrine, often face stricter insurance coverage rules due to high costs.
The Medicare Drug Price Negotiation Program will lower prices for Trelegy Ellipta and Breo Ellipta starting in 2027, with a $2,100 annual out-of-pocket cap for Part D plans.
For the estimated 16 million Americans living with chronic obstructive pulmonary disease (COPD (search)), medication adherence is a cornerstone of effective disease management — yet cost remains a formidable barrier. Research indicates that up to 19% of adults with COPD are unable to take their medications reliably due to financial constraints, a pattern that can worsen symptoms and hasten the decline of lung function.
"The progression of COPD (search) can be influenced by many things, including overall health, lifestyle habits, use of pulmonary rehabilitation, and smoking cessation," says Gautam Sikka, MD, a pulmonologist at UTHealth Houston. "Taking medication as directed is definitely part of that list — it's a crucial aspect of managing COPD effectively."
The Financial Burden of COPD (search) Treatment
A real-world analysis of more than 11,000 participants newly diagnosed with COPD (search) found that the average annual cost was $620 for COPD-related expenses, with significant differences in out-of-pocket costs depending on therapy regimens. Treatment plans that included combinations of two or more medications carried the highest cost burden for patients.
Mark Courtney, RRT, a respiratory therapist at the American Lung Association (search), notes that affordability is often a major concern for people with lung disease. "It's not uncommon to see patients reduce their medication amount or try to go without meds as a way to save money," he says. "But that can lead to poor long-term outcomes and may even increase the amount of medication needed."
Newer medications — particularly those without generic alternatives — tend to be more difficult to get insurance coverage for, according to Courtney. These high-cost specialty medications, which face more stringent coverage rules, include biologic therapies such as dupilumab (Dupixent) and mepolizumab (Nucala), as well as inhaled nonsteroidal therapies like ensifentrine (Ohtuvayre). Even maintenance inhalers can strain a budget when multiple devices are required, leading to higher copays or direct costs.
Insurance Coverage and the Medicare Drug Price Negotiation Program
The first step in addressing affordability, experts advise, is a conversation with a healthcare provider. "Healthcare teams, including pharmacists, can be familiar with cost issues and may be able to help you navigate health insurance policy rules regarding medication coverage," says Courtney. Physicians may recommend brands with lower overall costs or those selected for the Medicare Drug Price Negotiation Program.
This federal program enables direct negotiation with pharmaceutical manufacturers for high-cost prescription drugs. Two brand-name inhalers for COPD (search) — Trelegy Ellipta and Breo Ellipta — are included in the program, with lower prices taking effect in 2027. Savings apply to all Medicare Part B and Part D plans. Additionally, Medicare has established a maximum out-of-pocket cap of $2,100 for Part D plans.
During open enrollment, patients can use the Medicare Plan Finder Tool to compare drug copays and deductibles across different Part D plans, entering their exact medications to identify the most affordable option.
Financial Assistance Programs
For seniors on fixed incomes, multiple assistance pathways exist. Medicare's Extra Help program, also called the Low-Income Subsidy, assists with Part D premiums, deductibles, and coinsurances. For 2026, eligibility requires an income cap of $23,940 for an individual and a resource limit of $18,090. Those who qualify pay up to $5.10 for generic drugs and $12.65 for brand-name drugs.
Courtney recommends the PAN Foundation (search) Fund Finder, a tool that checks eligibility across 200 patient assistance funds from nine charitable organizations. "Even if no patient assistance grants are available based on your specific situation and needs, the finder lets you enter your information and be notified as soon as a new opportunity becomes available," he says.
Manufacturer savings programs — known as copay cards, patient assistance programs, or coupons — are available from many pharmaceutical companies for individuals with commercial insurance, Medicare, Medicaid, or no insurance. After insurance pays its portion, these programs cover part or all of the remaining copay or coinsurance, typically with a monthly or annual cap.
Pharmacy savings programs offer additional options. SingleCare provides a discount card usable regardless of financial need or insurance status. The Medicine Assistance Tool, launched by the Pharmaceutical Research and Manufacturers of America, focuses on patient assistance resources. NeedyMeds and RxAssist maintain directories of prescription assistance programs.
The Clinical Imperative of Adherence
"Although there's no cure for COPD (search), proper management that includes medication adherence can reduce symptoms and improve quality of life," Courtney emphasizes. "Another advantage is that many of these medications have been shown to reduce the risk for exacerbations, keeping patients out of the emergency room or hospital."
Research underscores the stakes: up to 58.7% of people with COPD (search) who use inhaled medications take them incorrectly, increasing the risk of hospitalization and death. For patients on fixed incomes who may be tempted to cut back on medications when symptoms improve, Dr. Sikka warns that this can cause COPD to worsen faster than anticipated. The effort to secure affordable access, experts agree, is a critical component of long-term disease management.