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January 25, 2016

Spiriva – Half the Medicine Provided is Wasted

Filed under: Health,Retail — Edgar (aka MrConsumer) @ 5:35 am

This is a strange one.

Thomas A. wrote to Mouse Print* about Spiriva — an inhalation therapy drug for people with COPD (chronic obstructive pulmonary disease). The medicine comes in a metal canister that slips into an inhaler.


What caught Thomas’ attention was the net contents statement on two different inhaler boxes — the small size (for two weeks of use) and the large size (for four weeks of use).



Both contain exactly the same amount of medicine — four grams — but one canister provides 28 doses and the other 60. How could this be?

We called the company and spoke to a nurse there to try to understand how this was possible. She directed us to the patient information sheet packed in each box.


The SPIRIVA RESPIMAT cartridge for each strength has a net fill weight of 4 grams and when used with the SPIRIVA RESPIMAT inhaler, is designed to deliver the labeled number of metered actuations (60 or 28) …

It seems the company manufactures only one size of canister but sells two different inhaler mechanisms. One delivers two-weeks-worth of medicine (28 puffs) and the other four-weeks-worth (60 puffs). So basically, the two week version is overfilled, and half the medicine goes to waste.

Now, couldn’t a smart consumer who has to use this stuff on an ongoing basis just buy the two week version and use it for a month? Or if the inhalers really are different, first get a prescription for the four week size, and then subsequently refill it with a two-week canister and get four weeks of medicine out of it for half the price?

Nope. The company is not stupid.


When the labeled number of actuations (60 or 28) has been dispensed from the inhaler, the RESPIMAT locking mechanism will be engaged and no more actuations can be dispensed.

The cash price for a month’s supply of Spiriva is enough to take your breath away — about $400. The two week version is generally only available in hospitals or as a doctor’s sample.

If the company can afford to overfill the two week cartridges, that suggests the actual cost of the medicine must be minimal.

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  1. Could this be a violation of the law that says you can not have unnecessary packaging?

    Comment by Alexander — January 25, 2016 @ 8:34 am
  2. This is a straight insult to consumers who depend on medicine and a perfect example of why consumers desperately need policies that can shake up the medicine industry.

    If companies actually had to compete for consumer dollars then this wasteful and overpriced practice of wasting medicine would surely disappear.

    Comment by Wayne R — January 25, 2016 @ 9:23 am
  3. Sounds like the ink cartridges on my printer, you are really paying for the delivery device, not the product that is being delivered. And you can buy refills for both from your local chain drugstore. 😉

    Comment by Michael K — January 25, 2016 @ 9:53 am
  4. Well drug companies will say that it can cost 1 Billion bucks in development costs just to get one major drug to the market place.

    The cost of the medicine may be minimal, the jacked up price though is not.

    Comment by Richard — January 25, 2016 @ 11:03 am
  5. I don’t know about $1 billion, but there are surely significant costs to recoup beyond just the marginal cost of producing the drug and delivery device. Spiriva (tiotropium bromide) took 13 years to move from discovery (1991) to market (2004).

    Comment by cmadler — January 25, 2016 @ 11:53 am
  6. Here in the US, drug companies can simply charge what the market will bear. Cost to develop/manufacture is irrelevant. If a drug costs $10/person to develop & manufacture and can replace a $10,000 surgery, they will price it a little less than $10,000.

    The only group that negotiates medical charges based on the cost of providing medical care is Medicare. They are prohibited by congress to negotiate prescription costs.

    Market forces don’t function properly for medical care. Our government (or one political party), doesn’t want to stifle “innovation” by allowing price to be controlled.

    If you don’t like it talk to your congress critter. You’ll be dead before they do anything about it.

    Comment by Robert — January 25, 2016 @ 5:10 pm
  7. Even I am off base on a 2014 Tufts Center for the Study of Drug Development (CSDD) Study that pegs the cost of developing a prescription drug that gains market approval at $2.6 billion, a 145% increase, correcting for inflation, over the estimate the center made in 2003.

    Comment by Richard — January 25, 2016 @ 7:57 pm
  8. shouldn’t this be reported to FDA. if it does dispense more than prescribed this could be dangerous.

    Edgar replies: Robert, there is nothing here to report to the FDA. The units never give you more doses than what is labeled. They only give you less than the actual content on the smaller size but the number of doses is still the exact number stated on the label.

    Comment by Robert — January 26, 2016 @ 5:27 pm
  9. A number of years ago, the method of delivering inhalation medicines had to be changed for environmental issues. The current method was developed and copyrighted. That copyright is the reason for the high cost of delivering inhalants. I use albuterol, which has been around forever, and which, before the change in delivery method, was nominally priced. Now? A month supply runs close to $150.

    Comment by Gin — January 27, 2016 @ 7:45 am
  10. Just another way to rip us off I use the inhailer with the plastic caps but still worry about if im in hailing the plastic

    Comment by janene strange — February 2, 2016 @ 6:02 pm

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