What COPD Inhalers are Covered by Medicare?

Chronic Obstructive Pulmonary Disease (COPD) affects more than 16 million Americans, with older adults making up the vast majority of diagnosed cases. For those on Medicare, understanding how and whether your inhalers are covered is essential—not only to manage symptoms, but also to avoid unexpected costs.

This guide breaks down how Medicare covers COPD inhalers, how to distinguish between types of inhalers, what your out-of-pocket costs might look like, and how to get help if you're facing high costs or confusing restrictions.

Understanding COPD Inhalers and Their Role in Treatment

COPD damages the lungs, narrowing the airways and making it difficult to breathe. Inhalers are the cornerstone of treatment, delivering medication directly to the lungs to reduce symptoms such as:

• Shortness of breath
• Wheezing
• Chest tightness
• Chronic coughing

There are several types of delivery systems for COPD medication:

• Metered-dose inhalers (MDIs) use a propellant to deliver a consistent dose.
• Dry powder inhalers (DPIs) release medication when you breathe in sharply.
• Soft mist inhalers provide a slower-moving spray that can be easier to inhale.
• Nebulizers, which Medicare Part B may cover, turn medication into a mist through a mask or mouthpiece.

Getting the most out of your inhaler depends on proper technique. Your doctor or pharmacist can help you learn how to use it correctly. Inhalers are typically just one part of a broader COPD treatment plan, which may include oxygen therapy, pulmonary rehab, and lifestyle changes.

Medicare Coverage Basics for COPD Inhalers

Inhaler coverage depends primarily on your Medicare plan. Here's how each part plays a role:

• Medicare Part B covers nebulizers and medications used with them if deemed medically necessary. It does not cover handheld inhalers.
• Medicare Part D covers most prescription COPD inhalers, including both brand-name and generic options.
• Medicare Advantage (Part C) combines Parts A, B, and usually D. These plans vary in their formularies and may offer extra benefits.

To find out if your inhaler is covered, check your plan’s drug formulary—a list of approved medications grouped into pricing tiers. Generally:

• Tier 1 = preferred generics (lowest cost)
• Tier 2 = non-preferred generics
• Tier 3 = preferred brand-name drugs
• Tier 4+ = non-preferred or specialty drugs (higher cost)

Your total costs can include:

• Monthly premiums
• An annual deductible
• Copayments or coinsurance

In 2025, Medicare will cap out-of-pocket drug costs at $2,000 and offer a monthly payment plan to help spread expenses over the year—a major improvement for those managing chronic diseases like COPD.

Commonly Covered COPD Inhalers Under Medicare

Most Medicare drug plans cover a wide range of inhalers, though costs and requirements differ by plan. Commonly covered inhalers include:

Short-acting bronchodilators (rescue inhalers):

• Albuterol (ProAir, Ventolin, Proventil)
• Levalbuterol (Xopenex)

Long-acting bronchodilators (maintenance inhalers):

• Salmeterol (Serevent)
• Formoterol (Foradil, Perforomist)
• Arformoterol (Brovana)
• Indacaterol (Arcapta)

Long-acting muscarinic antagonists (LAMAs):

• Tiotropium (Spiriva)
• Umeclidinium (Incruse)
• Aclidinium (Tudorza)
• Glycopyrrolate (Seebri)

Combination inhalers:

• LABA/ICS combos like Advair, Symbicort, Breo
• LAMA/LABA combos like Anoro, Stiolto
• Triple therapy (LABA/LAMA/ICS) like Trelegy and Breztri
  • Some research suggests that earlier use of triple therapy inhalers—those combining a LABA, LAMA, and corticosteroid—may delay lung function decline and reduce mortality. More long-term clinical evidence is needed to confirm these benefits.

Inhalers like Advair, Symbicort, Breo, Trelegy, and Breztri include inhaled corticosteroids (ICS) to reduce airway inflammation in moderate to severe COPD. These are typically prescribed in combination with long-acting bronchodilators. Because ICS can increase certain risks—like pneumonia—Medicare plans may require step therapy or prior authorization for these inhalers.

Some brand-name inhalers have generic versions that are FDA-approved for equivalence, though differences in inhaler devices may affect ease of use.

Difference Between Rescue Inhalers and Maintenance Inhalers in Medicare Coverage

There are two major categories of COPD inhalers:

Rescue inhalers provide fast-acting relief during sudden symptom flare-ups. These are usually covered under Medicare Part D and often placed on lower formulary tiers.

Maintenance inhalers are used daily to control inflammation and prevent exacerbations. These include long-acting bronchodilators and combination inhalers. Because they tend to be more expensive, they may be placed on higher tiers, triggering more cost-sharing.

Medicare plans typically cover both types, but quantity limits, prior authorizations, and step therapy requirements can affect access—especially for brand-name maintenance inhalers.

Patients with severe COPD are usually prescribed both. Your doctor can help document why each is medically necessary, especially if you’re requesting an exception or appeal.

Medicare Part D Coverage and Costs for COPD Inhalers

Each Medicare Part D plan has its own structure, but most follow a similar benefit design:

• Deductible phase: You pay full price until your deductible is met.
• Initial coverage: You pay your share (copay or coinsurance).
• Catastrophic coverage: In 2024, the catastrophic phase of Part D was redesigned so that patients no longer pay cost-sharing after reaching it. In 2025, a new $2,000 annual out-of-pocket cap replaces the old structure entirely.
• 2025 and beyond: Medicare implements a new $2,000 out-of-pocket maximum.

Inhalers may fall into different formulary tiers, which impact cost. If your inhaler is on a higher tier, you might pay:

• $40–90 per month for brand-name medications
• Less for generics, depending on the pharmacy and plan

Some plans also impose step therapy, requiring you to try a cheaper inhaler before a higher-tier one is approved. Always ask your plan if prior authorization is needed.

How to Get Medicare to Cover Brand-Name COPD Inhalers

If your preferred brand-name inhaler isn’t covered or is placed on a high-cost tier, you can request a formulary exception or a tiering exception. You’ll need your doctor to:

• Submit documentation of medical necessity
• Detail past failures with generic alternatives
• Describe any allergies or adverse reactions

If your request is denied, you can file an appeal. Decisions usually take 72 hours (or 24 hours for urgent cases). You can also continue treatment during the process under certain conditions.

These exceptions are often granted if your physician makes a strong case. Solace advocates can help gather the necessary information, coordinate with your doctor, and make sure the necessary paperwork is submitted properly.

Medicare Advantage Coverage for COPD Inhalers

Medicare Advantage plans typically include prescription drug coverage, but each plan has its own rules. Some offer:

• Lower copays for preferred inhalers
• Broader coverage for combination inhalers
• Access to medication therapy management programs

However, Medicare Advantage plans often come with:

• Narrow pharmacy and provider networks
• More prior authorization hurdles

When choosing a plan, be sure to:

• Compare formularies using the Medicare Plan Finder
• Confirm your preferred pharmacy is in-network
• Ask about inhaler coverage and costs before switching plans

Strategies to Reduce Out-of-Pocket Costs for COPD Inhalers

If you’re struggling with inhaler costs, several options can help:

1. Use financial assistance programs
   • Extra Help (Low-Income Subsidy)
   • Medicare Savings Programs
   • State Pharmaceutical Assistance Programs (SPAPs)
2. Switch to lower-cost options
   • Ask your doctor about generic or preferred formulary alternatives
   • Use mail-order or preferred pharmacies to save
3. Explore manufacturer assistance
   • Some brands offer copay cards or free medication programs
   • Solace advocates can help determine eligibility
4. Take advantage of new programs
   • In 2025, enroll in the Medicare Prescription Payment Plan to break up costs monthly

How an Advocate Can Help Reduce the Out-of-Pocket Cost of an Inhaler and More

When navigating inhaler coverage feels overwhelming, a Solace advocate can help. Advocates specialize in Medicare and support for chronic illnesses like COPD. Here’s how they assist:

• Plan review: Identify which plans cover your specific inhalers at the lowest cost
• Documentation support: Work with your doctor to submit prior authorizations, formulary exceptions, and appeals
• Cost reduction: Apply for Extra Help, manufacturer programs, and identify lower-cost pharmacy options
• Coordination: Make sure pulmonologists and primary care providers communicate effectively
• Transition support: Help maintain consistent inhaler access during hospital discharge or plan changes

If you rely on multiple inhalers, frequent refills, or expensive brand-name prescriptions, working with a Solace advocate can be a game-changer.

FAQ: Frequently Asked Questions About Medicare Coverage for COPD Inhalers

1. Does Medicare cover all types of COPD inhalers?

Not all, but many. Most Medicare Part D and Medicare Advantage plans cover common COPD inhalers, including rescue inhalers like albuterol and maintenance inhalers like Spiriva or Trelegy. Coverage depends on your plan’s drug formulary and tier placement, so it’s important to check your specific plan details.

2. Are rescue and maintenance inhalers covered differently under Medicare?

Yes. Rescue inhalers—used as needed for immediate relief—are often placed on lower-cost tiers. Maintenance inhalers, which are taken daily to control symptoms, are frequently more expensive and may require prior authorization or step therapy. Both types are covered under Part D but may come with different out-of-pocket costs and restrictions.

3. What does Medicare Part B cover for COPD treatment?

Medicare Part B doesn’t cover handheld inhalers. However, it does cover nebulizers and the medications used with them if prescribed as medically necessary. It may also cover pulmonary rehabilitation and oxygen therapy for COPD management.

4. How much do COPD inhalers cost under Medicare?

Costs vary based on your plan and drug tier. Generic inhalers may cost as little as $10–$30 per month, while brand-name maintenance inhalers can cost $90 or more. In 2025, Medicare will implement a $2,000 annual out-of-pocket cap for prescription drugs, which will significantly limit total inhaler spending for many beneficiaries.

5. What can I do if my brand-name inhaler isn’t covered?

You can ask your doctor to request a formulary exception, showing why you medically need the brand-name version. If the request is denied, you can file an appeal. Medicare also allows you to request a tiering exception if your inhaler is on a higher-cost tier.

6. Do Medicare Advantage plans cover more inhalers than Original Medicare?

Medicare Advantage plans often offer broader or enhanced coverage, but they come with their own formulary rules, network restrictions, and prior authorization requirements. Some plans may offer better coverage for newer or combination inhalers, while others may not. Always compare plans before switching.

7. Can I get COPD inhalers through a mail-order pharmacy?

Yes. Many Medicare drug plans offer lower copays for 90-day supplies through mail-order services. These can be convenient and cost-effective, but make sure the pharmacy is within your plan’s preferred network to avoid higher costs.

8. Are there financial assistance programs to help pay for COPD inhalers?

Absolutely. You may qualify for the Extra Help program, Medicare Savings Programs, or assistance from pharmaceutical companies. Some states also offer SPAPs (State Pharmaceutical Assistance Programs). Solace advocates can help you determine what you’re eligible for and assist with applications.

9. What happens if I need more inhaler medication than my plan allows?

Medicare Part D plans often set quantity limits for safety. If you need more, your doctor can submit a prior authorization or exception request. If denied, you can appeal the decision with medical documentation showing why the higher quantity is necessary.

10. How can a Solace advocate help with inhaler coverage and costs?

Solace advocates are trained to help Medicare beneficiaries navigate inhaler coverage. They can:

• Review your plan's formulary for coverage options
• Help file prior authorizations and appeals
• Find lower-cost alternatives and financial aid programs
• Coordinate care between your doctors
• Assist during Open Enrollment to find better drug coverage

Their support can simplify a complex process and help you stay on track with the treatment you need.

This article is for informational purposes only and should not be substituted for professional advice. Information is subject to change. Consult your healthcare provider or a qualified professional for guidance on medical issues, financial concerns, or healthcare benefits.