Asthma
Biologics for the Treatment of Asthma
Asthma is a chronic lung disease that causes inflammation (swelling) in your airways. Swollen airways can lead to difficulty breathing, chest tightness, coughing, and wheezing. These are common asthma symptoms. They are usually treated with inhaled medicine and/or pills.
If you have moderate-to-severe asthma, you may have to take routine asthma controller medicine to decrease the swelling in your airways. Sometimes, these medicines are not enough to manage your symptoms. If your routine medicines are not working well on their own, an add-on controller therapy called a biologic might be an option for you.
What Are Biologic Treatments?
Biologic drugs (or biologics) are a kind of medicine that is made by living things, such as animals, plants, or bacteria. Many of these biologics are antibodies, which are proteins that are designed to block specific molecules (tiny particles) in the human body.
Asthma biologics work by disrupting cells or blocking specific molecules that trigger inflammation.
How Do Biologics Treat My Asthma?
Biologics treat your asthma by disrupting the specific cells or blocking specific molecules that make your airways swell after exposure to certain triggers.2 Trigger exposure causes the molecules in your immune system to work together to create swelling in your airways. Biologics attach to these molecules and prevent them from causing inflammation and symptoms.3
Different sets of molecules are responsible for certain types of immune reactions. Doctors have discovered which molecules are most active in the immune systems of people with moderate-to-severe asthma. This means that your health care provider might be able to prescribe a biologic that specifically treats your asthma symptoms. This is known as personalized medicine.
Your doctor will decide if asthma biologics would be helpful for you by looking at your symptoms, the type of medicine you are already taking, and blood test results. The two of you will discuss this information and decide on a treatment plan together. A member of your health care team may also reach out to you to review the treatment and answer any questions you might have.
How Do I Take a Biologic?
Most biologics can be taken at home or given in a doctor’s office every one to four weeks. They are given through an injection (shot) or intravenously (through a vein).
What Are the Current Biologics Available for Asthma?
As of 2023, there are six biologics approved by the Food and Drug Administration (FDA) for asthma. Please see the list below for more information about these treatments.
How Do FDA-Approved Biologics Target Specific Immune Molecules?
Each biologic affects your immune system in a different way. This section explains how the six FDA-approved biologic treatments target specific immune molecules.
NUCALA (mepolizumab) and CINQAIR (reslizumab) treat eosinophilic [EE-oh-sin-o-FILL-ick] asthma by targeting a molecule called interleukin-5 [enter-LOO-kin-5]. Interleukin-5 is also known as IL-5.4,5,6
FASENRA (benralizumab) targets the IL-5 receptor, where IL-5 binds, and so is similar to NUCALA and CINQAIR in terms of inhibiting the effects of IL-5 in the body.
If you have eosinophilic asthma, IL-5 molecules activate eosinophils (white blood cells) in your bone marrow and move them to your airways, where they cause swelling. This process is called the IL-5 pathway.
NUCALA and CINQAIR interrupt this pathway by blocking IL-5 molecules from communicating with eosinophils, while FASENRA prevents IL-5 from binding the receptor for IL-5 on eosinophils. This prevents eosinophils from moving to your airways and causing swelling.7
DUPIXENT (dupilumab) treats eosinophilic and oral corticosteroid (OCS)-dependent asthma by targeting the receptor (IL-4 receptor alpha chain) for molecules called interleukins 4 and 13 (IL-4 and IL-13).8,9 These are types of proteins produced by the immune system that play a role in asthma.
When you are exposed to an asthma trigger, your body produces IL-4 and IL-13 in response. These proteins cause inflammation in the airways, which makes it harder for you to breathe. They also cause an increase in mucus, which further blocks your airways.
DUPIXENT blocks IL-4 and IL-13 proteins from sending those signals. This helps reduce inflammation and mucus in the airways.9
XOLAIR (omalizumab) treats allergic asthma by targeting an antibody called immunoglobulin E [eh-mu-no-GLAH-byoo-lun-ee] (IgE). IgE triggers a chain reaction that leads to airway tightening.
If you have allergic asthma, your body responds to allergens by producing IgE. IgE tells other cells in your body to release histamine [his-ta-MEEN]. Histamine tightens the muscles around your airways, which makes it hard to breathe. This is part of the IgE pathway.
XOLAIR blocks IgE from communicating with cells that contain histamine. This prevents those cells from releasing histamine and tightening your airways.10
TEZSPIRE (tezepelumab-ekko) treats both allergic and eosinophilic asthma by targeting a molecule called thymic stromal lymphopoietin.11 Thymic stromal lymphopoietin is also known as TLSP.12
Exposure to asthma triggers or allergens causes your body to release TLSP. TSLP triggers a series of reactions in the immune system that cause the production of other proteins and cells that contribute to inflammation in the airways. This is all a part of the TLSP pathway.12 The TLSP pathway is present in both allergic and eosinophilic asthma.
TEZSPIRE works by blocking TLSP from communicating with other cells, which prevents many parts of your immune system from reacting to your asthma triggers.
What Are the Different Types of Moderate-to-Severe Asthma?
There are many types of asthma. Moderate-to-severe asthma can generally be categorized by “type 2” inflammation and “non-type-2” inflammation.
Eosinophilic asthma and allergic asthma are caused by type 2 inflammation.
People with eosinophilic asthma have high levels of white blood cells called eosinophils [EE-oh-sin-oh-FILLS]. Everyone has eosinophils in their immune system. You need them to fight infections and attack unwanted bacteria in the body. Normal levels of eosinophils help keep you healthy, but too many can cause swelling in your airways.13
People with allergic asthma have an overly active immune response to common allergens, like dust or pollen. If you have allergic asthma, breathing in an allergen will trigger your immune system to produce IgE antibodies. An antibody is a molecule that helps fight off harmful substances that enter your body. IgE antibodies release chemicals into your bloodstream that tighten the muscles around your airways, which makes it hard to breathe.14
Eosinophilic and allergic asthma can overlap. If you have severe allergic asthma, it is likely you also have high levels of eosinophils.
Non-type-2 asthma is also called non-eosinophilic asthma. Eosinophils are not present in the airway. Different types of white blood cells build up and cause inflammation. Certain lifestyle factors, such as obesity and smoking, can put you at higher risk for this type of asthma. People with this type of asthma usually do not respond to typical asthma treatments.
Six biologics currently are approved by the FDA for moderate-to-severe asthma. Xolair is approved for allergic asthma. Nucala, Fasenra, and Cinqair are approved for eosinophilic asthma. Dupixent may work for type 2 asthma more broadly (allergic and eosinophilic). Tezspire may work for all types of asthma. Tezspire is the only biologic approved for non-type-2 asthma.
How Do I Find Out What Type of Asthma I Have?
Biomarkers can help identify what kind of asthma you have. They are a wide range of measures that show what is going on in your body. These measures include the cells, molecules, or antibodies found in your tissues, blood, mucus, and other body fluids. Examples of asthma biomarkers are IgE antibodies, eosinophils, and fractional exhaled nitric oxide (FeNO).
Your doctor may ask you to give a blood or mucus sample and/or take a breathing test. These tests measure asthma biomarkers. The results will show your doctor what kinds of cells and molecules are part of the chain reaction in your immune system that make up your asthma symptoms. They will also help identify the specific type of asthma you have. You and your doctor will discuss test results and decide on the best treatment plan for you.
Do I Need to Take a Biologic for My Asthma?
Biologics are a type of controller treatment. Your doctor may prescribe one if you have moderate-to-severe asthma that remains uncontrolled even though you use your routine inhaled medicines or pills regularly.
Your asthma may be uncontrolled if:
- You have asthma symptoms more than two times a week
- You wake up at night with asthma symptoms more than two times a month
- You need your reliever inhaler for symptoms more than two times a week
- You need to take oral corticosteroids more than one time a year
- You are not able to do all your usual activities
Biologics are an add-on treatment. This means your doctor may have you take them with your routine asthma controller medicine, like an inhaled corticosteroid. Over time, you may be able to reduce your inhaled corticosteroid use or stop taking it altogether. Asthma biologics do not replace quick-relief medicines, such as albuterol.
What Are the Benefits of Biologics?
There are many potential benefits of using a biologic to treat your asthma. They include:
- Fewer asthma episodes and symptoms
- Fewer asthma-related trips to the hospital or emergency room
- Decreased use of oral corticosteroids (like prednisone)
- Lower dosage of other controller medicines (if recommended by your doctor)
- Improved lung function
Do Biologics Have Potential Risks or Side Effects?
The FDA has approved six asthma biologics. This means that these treatments are safe and work well for most people. Even though biologics are typically harmless, side effects are still possible. This is true for all medicines and treatments.
Common side effects of biologics include:
- Headache
- Reaction where the biologic is injected
- Sore throat
- Tiredness (fatigue)
- Joint pain
- Skin rash
In rare cases, biologics can also cause a serious allergic reaction called anaphylaxis.
Certain treatments, like Xolair, have a black box warning. This is a safety warning from the FDA. It means you need to be aware of the drug’s side effects and special instructions for safe use. It is important to speak with your doctor before, during, and after starting Xolair or any other new medicine or treatment.
How Long Does It Take for a Biologic to Work?
Biologics work differently for everyone and may not take effect right away. It might be several weeks before you start to notice your asthma is getting better. Keep taking your biologic and any other asthma medicine you have been prescribed until your doctor says it is safe to stop.
Will My Insurance Cover Biologic Treatments?
Many insurance companies will pay for part of a biologic treatment. You will be responsible for paying whatever amount they do not cover.
Most insurance companies consider biologics to be a specialty treatment and may fill it through a specialty pharmacy. This means you may have to have your insurance company preapprove it and you will not be able to get it from your local pharmacy. Biologics can be more expensive than other controller medicines. Your insurance company will have more information on the purchase price and which asthma medicines are covered by your plan.
The drug companies that make biologics may also put information about costs and coverage on their websites. Many of them have patient assistance programs for people without insurance and people whose insurance does not cover asthma biologics. These programs may also help pay copays for people who have insurance that doesn’t fully cover the cost.
Medical Review: November 2023 by Mitchell Grayson, MD
Closed
Drug Company Assistance Programs
The medicines covered by the programs below may change at any time. The following medicines are covered as of Jan. 24, 2025.
Company:
- AstraZeneca
Medicines offered:
- AIRSUPRA®
If you have commercial insurance: If you have employer-provided or individual private (commercial) insurance, you may be able to get AIRSUPRA for as low as $0 with the SUPRA Savings Card.
If you have government insurance: For people with Medicare Part D coverage, the average out-of-pocket cost is $89 per month. For people with Medicaid, the out-of-pocket costs range from $.99-$13 per month. Some states offer even lower copays or eliminate the copay altogether. If you have Medicare Part D and cannot afford AIRSUPRA, you may be eligible for the patient assistance program, AZ&Me.
If you have no insurance: If you do not have health insurance or your insurance does not cover AIRSUPRA, you will pay the amount determined by your pharmacy. You may also be eligible for the patient assistance program, AZ&Me.
Learn more on the Cost Assistance with AIRSUPRA website or call 866-480-0030.
Company:
- AstraZeneca
Medicines offered:
- BEVESPI AEROSPHERE®
- BREZTRI AEROSPHERE®
- SYMBICORT®
- FASENRA®
- TEZSPIRE®
If you have commercial insurance, government insurance, or no insurance:
AstraZeneca US Patient Support offers various savings for several of their medicines. They offer copay savings cards and patient assistance programs depending on what type of insurance you have.
For more information, visit AZPatientSupport or call 800-236-9933.
AstraZeneca has capped the cost of their inhalers to $35 if you have commercial or private insurance. Learn more about the price cap.
Company:
- AstraZeneca
Medicines offered:
- TEZSPIRE®
If you have commercial insurance: The TEZSPIRE Together Co-Pay Program can help may help you save regardless of income if you qualify. Get doses for as little as $0 and up to $100 off your in-office administration costs (pre-filled syringe only). Learn more on the TEZSPIRE Together Co-Pay Program website or call 888-987-7473.
If you have government insurance: The TEZSPIRE Together Program, you may be able receive TEZSPIRE at no cost if you qualify. This includes people who:
- Are uninsured
- Have Medicare Part B with no supplemental insurance
- Have a Medicare Advantage plan with an affordability gap
- Have insurance that does not cover TEZSPIRE
For more information, call 888-987-7473.
Company:
- Boehringer Ingelheim
Medicines offered:
- Atrovent® HFA
- Combivent® Respimat®
- Spiriva® Respimat®
- Stiolto® Respimat®
- Striverdi® Respimat®
If you have commercial insurance or don’t have insurance: If you qualify, your cost will automatically be discounted when you buy these inhalers at participating retail pharmacies. If your cost is more than $35, download and use a savings card. Learn more at: InhalerOffer.com
If you have government-funded insurance: If you use Medicare, Medicaid, CHIP, or TRICARE, visit the Boehinger Cares Patient Assistance Program webpage or call 800-556-8317 to apply for assistance.
Boehringer Ingelheim has capped the cost of their inhalers to $35 if you have commercial or private insurance. Learn more about the price cap.
Company:
- Sanofi and Regeneron Pharmaceuticals, Inc.
Medicines offered:
- DUPIXENT®
If you have commercial insurance: The Dupixent MyWay® Copay Card may help you lower the cost of your copay. Learn more on the Dupixent MyWay Copay Card website or call 844-DUPIXENT (844-387-4936), option 1.
If you don't have insurance or your insurance doesn’t cover Dupixent: You can apply for the DUPIXENT MyWay Patient Assistance Program. For more information or to sign up, call 844-DUPIXENT (844-387-4936), option 1.
If you have Medicare: At this time, there is not a savings program for Dupixent if you have Medicare. Call 844-DUPIXENT (844-387-4936), option 1 for more information.
If you have Medicaid: Your copay and coverage may vary depending on what state you live in. If you meet the criteria, you may also be able to get help from the DUPIXENT MyWay Patient Assistance Program. For more information or to sign up, call 844-DUPIXENT (844-387-4936), option 1.
Medicines covered:
- Epinephrine devices – all brands
Savings programs:
- See AAFA’s list of all available epinephrine devices and their patient assistance programs.
Company:
- Genentech
Medicines offered:
- Xolair®
If you have commercial insurance: Genentech offers a copay savings program for Xolair. You may also be able to get help from an independent copay assistance foundation. 
If you have government insurance or don’t have insurance: You may be able to get help from an independent copay assistance foundation. Find programs.
Company:
- GSK (GlaxoSmithKline)
Medicines offered:
- ARNUITY ELIPTA
- ANORO ELLIPTA
- BREO ELLIPTA
- INCRUSE ELLIPTA
- NUCALA®
- SEREVENT®
- TRELEGY®
If you have commercial insurance: You may be eligible for the GSK Copay Assistance Program.
If you have Medicare or no insurance: You may qualify for the GSK Patient Assistance Program. This program can help you receive certain GSK prescription medicines and vaccines at no cost.
For more information, visit GSK Patient Assistance Program & Savings Offers or call 888-825-5249.
GSK has capped the cost of their inhalers to $35 if you have commercial or private insurance. Learn more about the price cap.
Company:
- GSK (GlaxoSmithKline)
Medicines offered:
- NUCALA®
If you have commercial insurance: If you have a commercial medical or prescription insurance plan, you may be able to take part on the NUCALA Copay Program. If you are approved, the GSK Copay Program may help with your cost share for NUCALA and the your cost share for administration up to the total annual copay program maximums.
If you have government insurance or no insurance: You are not eligible for this program if you are covered by any federal or state prescription insurance program.
For more information, visit the NUCALA Copay Program website or call 800-691-1939.
Company:
- Organon
Medicines offered:
- ASMANEX® HFA
- ASMANEX® TWISTHALER®
- DULERA®
If you have commercial insurance: If you qualify, you may be able to save with an ASMANEX Multiuse Savings Coupon.
If you qualify, you may pay as little as $15 per Dulera prescription on each of up to 12 qualifying prescriptions. The maximum savings is $90 per prescription.
If you have government insurance or no insurance: At this time, there is no assistance program if you have Medicaid or Medicare.
Company:
- Teva
Medicines Covered:
- QVAR RediHaler®
- CINQAIR®
Teva Cares Patient Assistance Program provides certain Teva medicines at no cost if you live in the United States and meet specific insurance and income criteria. Learn more about program eligibility.
If you do not meet the eligibility requirements for the Teva Cares Foundation Patient Assistance Programs, you may be eligible for help from other programs they offer.
For more information, visit the Teva Cares Foundation website or call 888-838-2872.
Pharmacy Drug Savings Programs
Program Name:
Contact Information:
- 844-265-6444
- moc.htlaehknilb@ofni
About the Program:
- Blink Health finds the lowest price for the medicines you need. Find discounted prescription prices on more than 15,000 medicines.
Program Name:
Contact Information:
- 844-926-2480
- moc.xrknilb@troppus
About the Program:
- BlinkRx is a digital pharmacy service that carries certain medicines. They can provide the lowest prescription price while providing free home delivery.
Program Name:
Contact Information:
- 855-268-2822
About the Program:
- GoodRx is a free resource that lets you compare medicine prices and find discounts.
Looking for savings on asthma inhalers? See the GoodRx Savings Guide for ways you may be able to save money on 25 asthma inhalers.
Program Name:
Contact Information:
- 833-317-2937
About the Program:
- The Kroger Health Savings Club is an annual membership program that entitles members to reduced prices on prescription drugs.
Program Name:
Contact Information:
About the Program:
- Mark Cuban CostPlus Drug Company offers access to affordable medicines at the lowest possible price. Learn about program eligibility.
Program Name:
Contact Information:
- 888-331-1002
About the Program:
- The SCBN Prescription Assistance program is for uninsured or underinsured people who cannot afford their prescribed medicines.
- The program requires a membership fee to participate.
Program Name:
Contact Information:
- Contact your local Walmart pharmacy
About the Program:
- The Walmart low-cost Prescription Program includes up to a 30-day supply for $4 and a 90-day supply for $10 of some covered generic drugs at commonly prescribed dosages. Prices for some drugs covered by the program may vary by state.
Program Name:
Contact Information:
- 877-296-4673
About the Program:
- Prescription Hope provides access to brand-name medicines for only $60 a month per medication through their medication access service. Learn about program eligibility.
Nonprofit Copay and Premium Assistance Programs
Organization:
Contact Information:
- 800-511-5144 (TTY 711)
- moc.htlaehairaca@eracremotsuc
About the Program:
- AcariaHealth provides specialty pharmacy services for people living with complex and chronic health conditions. Their Copay Assistance Support Team will research and apply to qualifying patient assistance programs on behalf of the patient. Learn about the program.
Organization:
Contact Information:
- 800-366-7741
About the Program:
- Accessia Health provides financial help to pay for copays, health insurance premiums, travel costs, and other medical expenses. Learn about program eligibility.
Organization:
Contact Information:
- 877-968-7233
About the Program:
- Good Days provides financial support for people who cannot afford the treatment they urgently need.
- Copay, travel, premium, and diagnostic testing assistance may be available.
- Learn about eligibility criteria.
Organization:
Contact Information:
- 980-859-3483
- gro.htaprobrah@ofni
About the Program:
- Harbor Path delivers lifesaving medicine for free to people who are uninsured. They currently serve 24 states. Use the eligibility calculator to see if you qualify.
Organization:
Contact Information:
- 800-675-8416
- gro.noitadnuofllewhtlaeh@stnarg
About the Program:
- HealthWell Foundation provide financial assistance to help with prescription copays, travel costs, behavioral health services, health insurance premiums, deductibles, and copays. Please note that diseases covered may change from time to time.
Organization:
Contact Information:
- 866-316-7263
About the Program:
- The PAN Foundation offers financial help for out-of-pocket medicine costs including copays, health insurance premiums, and transportation costs related to medical care. Learn about program eligibility. Please note that diseases covered may change from time to time.
Organization:
Contact Information:
- 866-512-3861
About the Program:
- PAF’s Co-Pay Relief (CPR) program provides direct financial help to qualified people with co-payments, co-insurance or cost-sharing associated with prescription drugs through funds for specific disease states. Learn about program eligibility. Please note that diseases covered may change from time to time.
Organization:
Contact Information:
- 800-769-3880
About the Program:
- Rx Outreach provides discounted medicines for eligible people. Learn about the program.
Organization:
Contact Information:
- 855-845-3663
About the Program:
- TAF helps people and families by providing them with financial help for their copays, coinsurance, premiums, deductibles, and other health-related expenses.
Patient Assistance Tools and Databases
Tool:
- BenefitsCheckUp® – National Council on Aging
Contact Information:
- 800-794-6559
More Information:
- BenefitsCheckUp® is a free service of the National Council on Aging (NCOA). It is an online tool to connect older adults and people with disabilities to benefit programs such as health care, medicine, food, utilities, and more.
Tool:
Contact Information:
- 615-736-5075
- gro.epohfoyrasnepsid@ofni
About the Program:
- Dispensary of Hope provides medicine to communities, free of cost. They are a charitable medication distributor dedicated to providing pharmacies and clinics with reliable access to medication that was generously donated by pharmaceutical manufacturers. Find a dispensing site near you, here.
Tool:
Contact Information:
- 800-503-6897
- gro.sdemydeen@ofni
More Information:
- A national nonprofit that connects people to programs that may help them afford their medicines and other health care costs.
Tool:
- PhRMA’s Medicine Assistance Tool (MAT) – Partnership for Prescription Assistance
Contact Information:
- 571-350-8643
More Information:
- PhRMA’s Medicine Assistance Tool (MAT) is a search engine for many patient assistance resources offered by drug makers.
Tool:
Contact Information:
More Information:
- RxAssist offers a comprehensive database of patient assistance programs. Learn about the eligibility requirements.
Tool:
Contact Information:
- 844-234-3057
- moc.eracelgnis@troppus
More Information:
- SingleCare works with pharmacies on discounts on prescriptions. Look up prescriptions to find the lowest prices in your area.
Tool:
Contact Information:
- 800-719-5147
- moc.esnesxr@rednifsgnivasxr
About the Program:
- Walgreens Rx Savings Finder can help you find prescription discount cards that can help you find the lowest price on a medicine at Walgreens.
State Drug Assistance Programs
Organization:
- Extra Help – Social Security Administration
Contact Information:
- 800-772-1213
- (TTY 800-325-0778)
More Information:
- The Extra Help program helps people with limited income and resources lower or cut Medicare Part D costs.
Organization:
- State Health Insurance Assistance Programs (SHIPs) – National Technical Assistance Center
Contact Information:
- 877-839-2675
- gro.htlaehpihs@ofni
More Information:
- Free insurance counseling and help to Medicare-eligible people, their families, and caregivers.
Organization:
Contact Information:
- Contact your local county office.
More Information:
- CalAIM offers people on Medi-Cal access to services that address physical, behavioral, developmental, dental, and long-term care needs.
Organization:
- State Pharmaceutical Assistance Program – Medicare.gov
More Information:
- Find out if your state has a state pharmaceutical assistance program.
Organization:
- Pharmaceutical Assistance Program – Medicare.gov
More Information:
- Learn more about pharmaceutical companies that offer programs to help pay for prescriptions for people with a Medicare Drug Plan (Part D).
Community Resources
American Sleep Apnea Association: Assists people with sleep apnea who cannot afford their CPAP mask supplies through the CPAP Assistance Program.
Friends of Man: Receives applications for mobility equipment, prosthetics, home modifications, medical equipment, hearing aids, basic needs and much more. The referral must be made by a professional. This includes caseworkers, case managers, health care workers, social workers, school counselors, teachers, and clergy.
FoodFinder: A map of food pantries across the United States. Search your ZIP code to learn about free food assistance programs near you.
FundFinder: Helps you find financial assistance from charitable foundations.
Inspira Financial: Funds in a health savings account (HSA) or a health care flexible spending account (FSA) can be used for eligible medical expenses.
Society of St. Vincent de Paul: A national non-profit that provides local assistance and services.
United Way 211: The most comprehensive source of information about local resources and services in the country.
AAFA Regional Chapters
The AAFA New England Chapter has more information on drug assistance for Massachusetts residents.
The AAFA Michigan Chapter has more information on drug assistance for Michigan residents, including the Jared Williams Medication Fund (JWMF).
