Insurance Plans Restricted Lower-Emission Inhalers

A study found commercial health plans favor metered-dose inhalers over lower-emission alternatives.

Updated on Sept. 28, 2026 in Asthma

Isometric editorial illustration of a single medical inhaler on a flat, sterile clinical platform. — A study of 31,219 health plans found that commercial insurance often prioritizes high-emission metered-dose inhalers over propellant-free, lower-emission alternatives. AI Illustration. Upload story photo >

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Should insurance companies prioritize covering lower-emission inhalers over cheaper, higher-emission alternatives?

Commercial insurance plans across the United States frequently create barriers to accessing low-emission inhalers, according to a May 2026 study. The research examined 31,219 plans and found that coverage structures often prioritize higher-emission metered-dose devices.

Why it matters

Insurance formulary designs impact both patient access to diverse treatment options and the environmental footprint of healthcare delivery. By requiring prior authorization for propellant-free inhalers, current plans discourage the transition toward more sustainable medical devices.

A study of 31,219 commercial plans showed 66.4% covered only metered-dose short-acting beta2-agonist (SABA) inhalers. While 89.5% of plans covered propellant-free corticosteroids, only 61.8% of those provided preferred tier 1 or 2 access.

The players

Veterans Health Administration

This federal agency operates the largest integrated healthcare system in the United States.

The details

Researchers found that commercial insurance formularies frequently mandate prior authorization or step therapy for lower-emission, propellant-free inhalers. In contrast, standard metered-dose devices for short-acting beta2-agonists remain highly accessible, with 99.2% placed in lower-cost tier 1 or 2 coverage categories.

From 2008 to 2023, the Veterans Health Administration reduced inhaler-related emissions by 68 percent.
In 2021, the Veterans Health Administration renegotiated its formulary to prioritize specific inhaler types.
In May 2026, researchers completed an analysis of insurance plan formularies across the United States.

Health Landscape

This study contrasts current commercial insurance practices against the successful emission-reduction model established by the Veterans Health Administration's 2021 inhaler formulary transition. The findings highlight a divergence between public sector environmental health efforts and private insurer coverage policies.

Patients may face higher out-of-pocket costs or additional administrative hurdles when requesting propellant-free inhalers. You should consult with your healthcare provider to check your specific plan's formulary tier before attempting to switch devices.

The takeaway

Healthcare providers and patients can advocate for formulary updates that align with modern environmental and clinical guidelines. Understanding your coverage tier is essential for managing both the cost and the environmental impact of your daily asthma treatment.