I have mild bronchiectasis (basically chronic bronchitis) and have been managing very well using an albuterol inhaler. This spring, my pulmonologist suggested that I add Spirivia to this since that medication reduces the amount of mucus the body produces. I did this and it did improve the condition quite well. Like most of us on Part D, my main focus was on the copay. When I got my last monthly statement from United Health Care, I was shocked to see that I was only a few hundred dollars short of hitting the "donut hole" in their coverage. When you are in the donut hole, you pay 35% of the "suggested" drug cost. I only take 4 other prescription drugs that aren't that expensive. I got on the phone with them and shortly figured out the problem - Spirivia. Coverage is figured on "total drug costs" which is the suggested drug cost that the pharmacy charges to uninsured customers. My other medications weren't that much higher than the copay but Spirivia was through the roof! The CVS price for Spirivia was $429.04 meaning my copay would go from $42 to $150 each for the rest of the year. Luckily, there was a workaround for the situation. Atrovent (a medication similar to Sprivia) is available in liquid ampules to use in a nebulizer. A box of 50 ampules (25 day) supply costs less than $8 at CVS, the nebulizer with mask I bought for about $35 on Amazon. I'll start using this method in about 6 weeks when my Sprivia runs out. Why the huge difference? The nurse practitioner at my doctor's office explained that the German company making Sprivia has a patent on the DELIVERY DEVICE (inhaler), not the medication. That's how they are hosing the consumer.. For your own sake, if you are on Part D, check your monthly statements carefully to make sure you don't get blindsided by an expensive medication you're taking that could be replaced with a cheaper equivalent.