Preliminary evidence suggests that levalbuterol (LEV), the therapeutically active isomer of albuterol, can improve clinical outcomes while reducing health care costs compared to racemic albuterol (RAC). OBJECTIVE: Explore the impact of LEV versus RAC on resource utilization, co-medication use, and cost of therapy in asthmatics. METHODS: Claims data on patients prescribed LEV and RAC were obtained from the PharMetrics Integrated Outcomes Database. Age- and sex-matched samples of patients initiating therapy with LEV or RAC (no prescriptions for either agent in prior 6 months) were selected and their asthma-related charges were assessed over 6 months following the initial prescription. RESULTS: 544 LEV-treated patients were identified and matched to 544 RAC-treated patients. 70% of all patients were <12 years of age. 32% of RAC patients and 59% of LEV patients received asthma controller medication during the prior 6 months. Mean asthma-related (pharmacy and medical) charges during the prior 6 months were $872 versus $587 in the LEV and RAC groups respectively. During the 6 months follow-up period, controller medication use increased among RAC patients to 59%, while use among LEV patients remained unchanged. Overall mean charges decreased by $298 for LEV and $61 for RAC. In patients receiving concomitant controller medications, LEV was associated with a $247 decline in charges versus a $116 increase for RAC. Among patients treated in primary care (pediatricians, family practitioners, and internists), the reduction in mean charges was $262 for LEV, while RAC was associated with a $180 increase. CONCLUSIONS: 1) LEV was prescribed to patients who were “sicker” than those prescribed RAC; 2) Patients treated with RAC, but not LEV, tended to require additional controller medications; 3) LEV was associated with greater reduction in total cost compared to RAC, which in “sicker” and primary care patients was associated with increased cost.