Comparing Spiriva HandiHaler To Spiriva Respimat

In our latest question and answer, the pharmacist compares the Spiriva HandHaler and Spiriva Respimat.

Comparing Spiriva HandiHaler To Spiriva Respimat
Jan 27, 2019

lynn asked

What is the cost difference between the Spiriva HandiHaler and the Respimat? Is one more expensive than the other? Thank you!


There are several differences between the Spiriva HandiHaler and the Spiriva Respimat that I will discuss. Since you are curious about cost, I will touch on that first.

Spiriva Cost

The difference in cost between Spiriva Hanihaler and Spiriva Respimat will vary based on two key factors:

  • The pharmacy
  • Your insurance plan

Pharmacy 'Cash' Cost For Spiriva

If you are paying 'cash', meaning without insurance, the price for both Spiriva products will vary depending on which pharmacy you go to. The price at Rite-Aid may be different than the price at Walgreens for example.

In term of the costs, somewhat surprisingly, the 'cash' cost for both medications is about the same, even though Spiriva Respimat is the 'newer' version of the drug.

There could be some variation but on average, both cost around $400-$450 for a one-month supply (one box of the HandiHaler or one Respimat inhaler).

Medication pricing by Elsevier lists both Spiriva HandiHaler and Spiriva Respimat at $432.20., which gathers drug prices and offers discount coupons, lists the average cash price of Spiriva Respimat at $446.

Spiriva Respimat Costs


For the Spiriva Handihaler, it lists the average cash price at $452.

The Spiriva Handihaler was first approved by the FDA in 2004 while Spiriva Respimat was approved in 2014.

Part of the reason why the Respimat is essentially the same price. is because the manufacturer, Boehringer-Ingelheim wants individuals to switch from the Handihaler to the Respimat.

Insurance Cost For Spiriva

If you have insurance, the price for the Spiriva Handihaler and Respimat will depend on your specific plan. As there are countless plans available, your best option is to look at your 'formulary' to see if they are covered and if so, what 'tier' they are on.

Insurance plans differ, but in general, they have several (between 2 and 5) tiers, each with different co-pays.

For one example, here is the tier structure for Blue Cross and Blue Shield's Federal Employee Program:

  • Tier 1 Generic Drugs
  • Tier 2 Preferred Brand Name Drugs
  • Tier 3 Non-preferred Brand Name Drugs
  • Tier 4 Preferred Specialty Drugs
  • Tier 5 Non-preferred Specialty Drugs

Low tiers have lower co-pays, while the high tiers will have high co-pays.

Blue Cross Spiriva Formulary

For this plan, looking at their formulary, they list both the Spiriva HandiHaler and the Spiriva Respimat as tier-2 drugs (preferred brands). Therefore, they should be the same price, whatever your co-pay is set at for Tier 2 drugs.

Your best bet is to read and understand your specific insurance plan to determine how your co-pay structure works as well as what Tier both Spiriva products are on.

What Is The Difference Between Spiriva Respimat and Spiriva Handihaler?

Both Spiriva products contain the same active ingredient (tiotropium) but in a different dosage form and they use different devices. Other key differences are discussed below as well.

Dosage Form

The Spiriva Handihaler uses a dry-powder that is inhaled from the device after puncturing a capsule, while the Spiriva Respimat is a soft mist spray.


The Spiriva HandiHaler device pierces a capsule that is placed in the central chamber. This allows the dry-powder inside the capsule to be inhaled via the HandiHaler mouthpiece.

Spiriva HandiHaler

Spiriva HandiHaler

The Spiriva Respimat looks more like a traditional inhaler and does not use dry-powder. Instead, it generates an aerosol cloud of medication that is inhaled.

Spiriva Respimat

Spiriva Respimat


The Spiriva Respimat is available as:

  • 1.25 mcg/actuation
  • 2.5 mcg/actuation

Spiriva Handihaler only comes in one strength, 18mcg per capsule.

Although the Handihaler dose is higher, the dosage from the Respimat is better absorbed and the prescribing information states that two 2.5 mcg doses of Respimat work about the same as one 18 mcg dose of the HandiHaler:

A dedicated pharmacokinetic study in patients with COPD evaluating once-daily tiotropium delivered from the RESPIMAT inhaler (5 mcg) and as inhalation powder (18 mcg) from the HandiHaler resulted in a similar systemic exposure between the two products.


Both the HandiHaler and the Respimat are FDA-approved for the treatment of COPD (chronic obstructive pulmonary disease).

However, only the Respimat is approved to treat asthma.

The dosing relative to each indication for both are:


Spiriva Respimat: 2 actuations (2.5 mcg per actuation, 5 mcg total) via oral inhalation once daily. . Administer at the same time each day.

Spiriva HandiHaler: 2 inhalations of the contents of a single capsule (18 mcg) once daily using the Handihaler device at the same time each day.


Spiriva Respimat: 2 actuations (1.25 mcg per actuation, 2.5 mcg total) once daily. Administer at the same time each day.

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