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For more than three decades, drugmakers have used various tactics to win and extend monopolies on inhalers for combating asthma and chronic obstructive pulmonary disease, which thwarted lower-cost generic competition that could have saved patients and payers countless dollars, a new analysis finds.

These moves included winning patents on the devices, not just the medications in the devices; combining old ingredients into new inhalers; shifting ingredients from one inhaler to another; and adding new patent and exclusive rights bestowed by regulators after approvals. One tactic lengthened the average time from approval to the last expired patent or regulatory exclusivity on follow-up inhalers to 28 years.

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