Aswitch in Medicaid’s formula could mean many children will go without inhalers in the coming months.

The process change means drugmakers have to pay Medicaid if list prices on older products are higher than current inflation rates. While the change made the most impact on insulin prices, inhalers also are dropping, so companies can get around the new rule.

Already, three of the largest inhaler manufacturers said they’d be capping inhaler co-pays at $35 monthly. That includes Boehringer Ingelheim, AstraZeneca PLC and GlaxoSmithKline for the Advair Diskus and Advair HFA inhalers as well as Symbicort and Spiriva HandiHaler and Atrovent HFA units. The companies have also lowered several list prices in what is good news for patients on a budget.

The companies have not acknowledged the price cuts as a reaction to the new Medicaid rebate update, and some say they are reflective of their desire to reduce barriers of access to lifesaving medications.