Popular Asthma Inhaler Discontinued, Alternatives Exist

Flovent disappeared Jan. 1, when GSK pulled it. Insurers dropping coverage and Medicaid rule changes likely incentivized the move to protect profits.

A Flovent inhaler. Colleen Michaels/Shutterstock

For millions suffering from asthma, the common symptoms of wheezing, shortness of breath, and chest tightness are controlled effectively with Flovent. But on Jan. 1, this very common asthma inhaler was abruptly discontinued by manufacturer GlaxoSmithKline (GSK).

Now, blindsided patients are wondering why this crucial medication that keeps their condition in check was pulled from shelves and what last-ditch alternatives remain for them to manage their symptoms, which can be life-threatening if left untreated.

Insurers Were Already Shifting Away From Flovent

Earlier this month, a post from the Asthma and Allergy Foundation of America (AAFA) revealed that GSK would remove its popular, brand-name inhaler, Flovent, from the market to offer only a generic version of the drug.

Since at least last year, there has been online discussion on the social media platform Reddit about insurance companies increasingly dropping their coverage of the branded Flovent inhaler. This forces asthma patients to switch to alternatives like the Pulmicort Flexhaler, a dry powder inhaler (DPI) that has notable drawbacks.

Research has shown that proper training is required for the correct use of DPI devices, with one study finding that many patients used the devices inappropriately. Additionally, issues like humidity can interfere with powder dispersal if it causes the medication to stick inside the inhaler.

The insurance carrier shifts away from Flovent may be an attempt to cut costs, as the average cash price has increased 41 percent, from $207 to $292 between 2013 and 2018, according to data from GoodRx, a telemedicine platform that tracks prescription drug prices in the United States.

Medicaid Rebate Rule May Have Pushed GSK to Protect Profits

To address the escalating costs of prescription drugs, President Joe Biden’s Inflation Reduction Act instituted changes to the Medicaid Drug Rebate Program. These changes mandate that pharmaceutical companies pay rebates to Medicaid if they raise drug prices faster than the inflation rate.

This new rule may ultimately force drugmakers to sell medications at a loss to Medicaid. One way pharmaceutical companies can avoid losses is by significantly reducing their drug prices, as seen already with some insulin products. Another approach is the route GSK is taking.

Though potentially cheaper, the “authorized generic” version no longer has a price history. Therefore, it will not be subject to the new Medicaid rebate rules.

However, this switch has sparked concerns that out-of-pocket costs for patients could actually increase for the authorized generic fluticasone compared to the branded Flovent. “Authorized generics will provide patients in the US with potentially lower cost alternatives of these medically important products,” according to a GSK statement to the AAFA.

“The U.S. has a complicated drug pricing ecosystem,” the AAFA said in a press release about the discontinuation. “Manufacturers, pharmacy benefit managers, insurance companies, and federal policies can create situations that reduce access to critical medicines for patients.”

Safer Asthma Alternatives Exist: Expert

Flovent is an inhaled corticosteroid that controls and prevents asthma symptoms. However, switching to a nonsteroid alternative may be better for some patients, Nazlie Latefi, a molecular biologist specializing in respiratory diseases and co-founder and chief scientific officer at Applied Biological Laboratories Inc., told The Epoch Times.

Steroid medications for asthma can increase susceptibility to respiratory viral infections like colds or flu, she added.

Steroid drugs work by reducing lung inflammation through lowering levels of immune-signaling proteins called cytokines. While cytokines regulate inflammation, overactive levels can trigger “cytokine storms” that damage organs. They can also reduce helpful cytokines that fight infections early on, Ms. Latefi added. “That’s why steroids make you more susceptible to getting sick.”

She recommends patients talk to their doctors when considering alternatives to corticosteroid medications like Flovent.

Coverage by Health Insurers

Many health insurers will likely cover the generic fluticasone version of Flovent. For more immediate coverage, patients can request a formulary exemption from their insurance providers to help pay for this generic alternative.

However, patients should first consult their health care team and insurance provider to confirm coverage details, potential out-of-pocket costs, and other restrictions.

Without access to Flovent, asthma patients still have at least two other options to help control symptoms. They are:

• Other inhaled corticosteroids: Alternatives like beclomethasone, Pulmicort (budesonide), and Arnuity Ellipta (fluticasone furoate) are available, though these DPIs can be more difficult for patients to use properly. Patients should work closely with their health care providers to ensure correct administration technique and dosage.
• Combination inhalers: For patients needing both anti-inflammatory and bronchodilator medications, combination products like Advair (fluticasone + salmeterol) and Symbicort (budesonide + formoterol) deliver both drugs in one inhaler.