Same medicine, same puff of air. The patents mostly sit on the plastic device — and the 2024 Senate investigation laid the gap out in single lines. Honestly sorted, with every figure dated and sourced.
Researched with AI assistance; every figure is checked against the primary source cited on this page before publishing. How we work →
Figures come from CMS's NADAC pharmacy-acquisition database, the 2024 Senate HELP investigation record, the UK Drug Tariff, France's ANSM database, Ontario's public formulary, official price lists in Germany, Switzerland, Austria and the Netherlands, and peer-reviewed research. Where a number is a dated record, we say so — the $7 France figure is from the Senate's 2024 letters; the $497 US figure is current 2026 acquisition data.
| Country | Salbutamol 100 µg, 200 doses | In US dollars | What a patient typically pays |
|---|---|---|---|
| 🇬🇧 United Kingdom | £1.50 Ventolin, Drug Tariff base price (Dec 2025) | $2.00 | — |
| 🇳🇱 Netherlands | €3.24 (average pharmacy price, excluding the dispensing fee) | $3.62 | — |
| 🇦🇹 Austria | €5.50 Sultanol (social-insurance price excluding VAT) | $6.15 | — |
| 🇨🇭 Switzerland | CHF 13.60 (official public price) | $16.46 | — |
| 🇩🇪 Germany | €18.78 Ventolin (statutory ceiling €21.62) | $21.01 | — |
| 🇺🇸 United States | No like-for-like official price — the ~$497 figure is for a different inhaler (Combivent Respimat) | — | — |
Conversions to US dollars at ECB rates of October 26, 2026, as in the chart. “—”: the article gives no figure for this.
| Market | Figure | Context | Source |
|---|---|---|---|
| United States | ~$497 / inhaler (2026 acquisition) | CMS's NADAC database prices Combivent Respimat at $124.29 per gram as of January 2026 — about $497 for the standard 4g/120-dose inhaler at pharmacy acquisition. The 2024 Senate investigation logged US list prices of $200–$600 across brand inhalers: Advair $319, QVAR $286, Combivent $489. | CMS NADAC (Jan 2026) · Senate HELP (2024) |
| France | $7 (Senate record, 2024) | The same Combivent inhaler appeared at $7 in France in the Senate's 2024 letters. France's own medicines database lists salbutamol (Ventoline) at about €3.41–€4.43 with 65% reimbursed — one negotiated national price. | US Senate HELP (2024) · ANSM |
| UK · Germany · Canada | £1.50 · $9 · CAD $6 | The UK Drug Tariff lists a 200-dose Ventolin at £1.50 base price (Dec 2025). Germany paid $9 for the QVAR that costs $286 in the US (Senate, 2024). Ontario's public plan lists Ventolin at about CAD $6. | NHSBSA · Senate HELP · Ontario ODB |
| Germany · Switzerland · Austria · Netherlands | €18.78 · CHF 13.60 · €5.50 · €3.24 | The same basic reliever as the UK's £1.50 Ventolin — a 200-dose salbutamol 100-microgram inhaler — appears in official lists in all four countries: Germany €18.78 for Ventolin (pharmacy price; the statutory insurers' ceiling, the Festbetrag, is €21.62 — list as of October 15, 2026); Switzerland CHF 13.60 (official public price, Federal Office of Public Health); Austria €5.50 for Sultanol (social-insurance price excluding VAT, November 2026); Netherlands €3.24 (average pharmacy price, excluding the dispensing fee, October 2026). That is roughly $4–$21 per inhaler at ECB rates of October 22, 2026. None of these lists carries Combivent Respimat itself, so the $497 US figure has no like-for-like official European price. | BfArM/GKV-SV Festbetrag list · BAG SL · Dachverband EKO · Zorginstituut |
| The catch — the $35 caps | voluntary, with holes | After the 2024 Senate investigation, three of the four companies (not Teva) announced $35 monthly caps. But they're voluntary company programs, not law; Medicare/Medicaid patients are generally excluded; and the Flovent authorized generic sits outside them — some insured families paid as much as $150 for a single inhaler (Senate Finance minority report, March 2026). Insured patients already averaged $11 generic / $33 brand per fill in 2023 claims. | Peterson-KFF · Senate report |
We compare what the inhaler costs, not what anyone should take, switch, or stop. Rescue and controller inhalers are different medicines with different roles — treatment decisions belong with you, your pharmacist, and a licensed prescriber.
When researchers at Health Affairs reviewed every inhaler the FDA approved in the modern era — 62 of them between 1986 and 2020 — they found 53 of the 62 were brand-name, shielded from generic competition for a median of 16 years. The tell: more than half of those patents didn't cover the drug at all. They covered the device — the casing, the dose counter, the mouthpiece. Move an old, off-patent medicine into a slightly new device and the monopoly resets; researchers call it device hopping. It's why Advair's first generic didn't arrive until 2019, and why Mylan said getting there cost more than $700 million.
The CFC propellant ban that took effect at the end of 2008 was environmental policy — but the cheap generic albuterol inhalers ran on exactly that propellant, and when the ban hit, they disappeared, leaving only patented brand versions. One JAMA Internal Medicine study measured privately insured patients' out-of-pocket albuterol costs rising from $13.60 to $25 per prescription — roughly an 84% jump. Brand-owned authorized generics only appeared in January 2019, and the first FDA-approved generic followed in February 2020. That's a decade-long blackout on one of the oldest, cheapest respiratory medicines on earth.
After the Senate HELP Committee opened its investigation in January 2024 and published the arbitrage in single lines — Advair $319 here, $26 in Britain; QVAR $286 here, $9 in Germany; Combivent $489 here, $7 in France — three of the four companies announced $35 monthly caps within months. Teva never committed. The caps are voluntary programs, not law; Medicare and Medicaid patients are generally excluded; and when GSK pulled Flovent on the exact day a new Medicaid rebate rule took effect (January 1, 2024), the authorized generic that replaced it sat outside the caps entirely, and some insured patients paid as much as $150 for a single inhaler — a move a Senate report, citing one study, estimated let GSK avoid about $367.6 million in Medicaid rebates in 2024 alone. The honest ending: the first true generic Flovent cleared the FDA in March 2026, and in national survey data from 2013–2020, roughly 1 in 6 American adults with asthma reported skipping or stretching medication because of cost.
Combivent Respimat runs about $497 at US pharmacy acquisition (CMS NADAC, January 2026) versus $7 in France per the 2024 Senate record. Advair: $319 US vs $26 UK. QVAR: $286 US vs $9 Germany (Senate HELP, 2024). The UK base price for a 200-dose Ventolin is £1.50 (NHSBSA Drug Tariff, Dec 2025).
Researchers reviewed all 62 inhalers the FDA approved between 1986 and 2020: median 16 years of protection from generic competition, and more than half the patents covered the delivery device, not the drug (Health Affairs). Moving an old medicine into a slightly new device resets the monopoly — researchers call it device hopping.
The 2008 CFC propellant ban removed generic albuterol from shelves; privately insured patients' out-of-pocket costs jumped from $13.60 to $25 per prescription (2004 to just after the 2008 ban, JAMA Internal Medicine). Brand-owned “authorized generics” appeared in January 2019, and the first FDA-approved generic HFA albuterol inhalers followed in 2020 — a gap of roughly a decade.
Partially. They're voluntary company programs, not law: Boehringer Ingelheim and AstraZeneca from June 2024, GSK by January 2025 — Teva made no commitment, and Medicare/Medicaid patients are generally excluded (Peterson-KFF). Insured patients already averaged $11 for a generic fill and $33 for a brand in 2023 claims data.
GSK discontinued Flovent on January 1, 2024 — the day a new Medicaid rebate rule took effect — and switched to an authorized generic through a partner. A March 2026 Senate minority report, citing one study, estimated GSK could otherwise have owed about $367.6 million in Medicaid rebates in 2024 alone; the authorized generic wasn't covered by GSK's $35 cap, and some insured patients paid as much as $150 for a single inhaler. The FDA approved the first true generic of Flovent HFA (Glenmark, 44 mcg) in March 2026.
Where governments set or negotiate one price, a basic reliever inhaler is cheap: the UK's base price for a 200-dose Ventolin is £1.50; Ontario's public plan lists it near CAD $6. Cost information, not medical advice — inhaler decisions belong with your prescriber and pharmacist.
Wellness Vision does not sell medication, book trips, or take referrals. Every figure above traces to the public sources cited — a federal pricing database, a Senate investigation record, peer-reviewed journals, regulators, and official tariffs. This is a cost comparison, not medical advice: nothing here tells anyone to start, stop, switch, or ration an inhaler, and asthma or COPD treatment decisions belong with you, your pharmacist, and a licensed prescriber.
📋 Or get the free Medical Cost Checklist — no email →
View provenance manifest for this video →
You shouldn't have to go broke to feel whole.
