Asthma Inhaler Switch in 2024 Could Leave Some Patients Scrambling

By   |  January 1, 2024

By Carole Tanzer Miller HealthDay Reporter  |  Copyright © 2024 HealthDay. All rights reserved.

FRIDAY, Dec. 29, 2023 (HealthDay News) — A popular asthma inhaler is being discontinued Jan. 1, fueling concerns that patients may have trouble getting insurance coverage for alternatives.

GSK, maker of the branded inhaler Flovent, will make "an authorized generic" version of the drug, but without the same branding.

While doctors say it will work just as well, it doesn't appear to be as widely covered by insurance, according to CNN. As a result, patients may be forced to get new new prescriptions and iron out insurance coverage at the peak of respiratory virus season.

"This medication has been the most commonly used inhaled medication for the past 25 or 30 years," Dr. Robyn Cohen, director of the Pediatric Pulmonary and Allergy Clinic at Boston Medical Center, told CNN. "It's the one that, overwhelmingly, pediatricians reach for when they decide that their patient needs a daily preventive medication. … The fact that it's being discontinued is going to be a huge shock to the system for patients, for families and for doctors."

Doctors urge patients to make sure they've got medicine lined up as the calendar turns to 2024.

A GSK spokeswoman told CNN the company is making the change "as part of our commitment to be ambitious for patients." 

She noted the company introduced the authorized generics of Flovent HFA, an inhalation aerosol, and Flovent Diskus, an inhalation powder, in 2022 and 2023 and said it would discontinue the branded versions in the United States on Jan. 1, 2024.

The generics are potentially lower-cost alternatives, the spokeswoman said.

But experts on the pharmaceutical industry told CNN that GSK is making the switch at a time when Medicaid rebate changes could saddle the company with large penalties because of previous price hikes on Flovent.

The change going into effect on Jan. 1 removes a cap on Medicaid rebates that pharmaceutical companies must pay if they hike prices more than inflation.

Until now, rebates were capped, so manufacturers would never repay Medicaid more than a drug costs. Removing that cap means drug makers that have had large price hikes over time could end up selling their medication at a loss.

"Obviously pharma doesn't want to be selling at a loss on anything in its portfolio," Andrew Baum, an analyst who covers pharmaceutical companies for the financial firm Citi, told CNN. "So it seeks to evade impact by, one: discontinuation; two: authorized generic." 

Since 2014, the price of branded Flovent has risen about 47%, according to GoodRx. No other generic versions of the drug are approved by the U.S. Food and Drug Administration.

CNN reported that GSK did price the authorized generic lower than the branded Flovent.

CVS Caremark, a major pharmacy benefit manager, is giving preferential placement to another branded inhaler, Pulmicort, instead of generic Flovent.

Based on net prices, "in this case, the authorized generics were more expensive than the brand name medications," a CVS spokesman told CNN.

For decades, Flovent has been the most often used daily medication among patients with persistent asthma. It reduces swelling in airways and reduces the response to triggers that interfere with breathing. It's crucial to have medication at this time of year, said Cohen.

"Flu, COVID, RSV -- all these circulating viruses that are going around right now -- are one of the biggest, if not the biggest, triggers for asthma attacks in kids," she said. "This is what leads to kids being in the emergency room."

She urges patients to find out what their insurance covers.

For patients with a rarer condition called eosinophilic esophagitis, Flovent HFA is one of the most often prescribed topical steroids. Alternatives have less information to support their use. 

"With the discontinuation coming up, I worry it's going to just be one more hurdle for this patient population that already has very limited medications available to them," said Dr. Erin Syverson, an attending physician at Boston Children's Hospital. "I don't know what January is going to be like, but I'm worried."

More information

The U.S. Centers for Disease Control and Preventiion has more about asthma.