If you have not heard already, one of the most popular inhalers has been discontinued by its manufacturer since January 1. GlaxoSmithKline (GSK) has stopped producing Flovent, which comes as a metered-dose inhaler (Flovent HFA) and as a dry powder inhaler (Flovent Diskus). This inhaler is not only used for asthma management, but is also used to treat a type of food allergy called eosinophilic esophagitis.
As I and many other experts have noted, the discontinuation comes at the same time as a change in Medicaid rebates that went into effect January 1, 2024. This change would have required GSK to pay large penalties due to price increases for Flovent over the years.
A provision in the 2021 American Rescue Plan Act removed a cap on Medicaid rebates that companies had to pay if they raised the price of a medicine by more than inflation. So, if GSK continued to sell Flovent in 2024 they would have likely had to pay more than the cost of the drug back to Medicaid. Therefore, discontinuing Flovent in favor of an authorized generic would allow the company to avoid this financial penalty.
I was not alerted to the discontinuation news until someone warned me on social media this past fall. The earliest warning I saw was from an announcement online from United Healthcare. Back in November I tried to warn people on social media that this medication was going to be discontinued, but the news cycle did not pick it up until a month later. While patients have not brought this medication change to my attention, I have been discussing it with all of my patients so that they are as prepared as possible for this transition. It’s important for healthcare providers and patients alike to be aware of this news and take steps to prepare for a medication change.
So, what exactly does this discontinuation mean — in terms of quality, cost, and alternatives — for our patients with asthma who rely on Flovent?
There have been authorized generics of Flovent HFA since May 2022 and Flovent Diskus since October 2023, and it does not appear that there are any quality concerns. I have neither seen problematic reports nor heard concerns from patients.
However, I am very concerned that many people have not received enough advance warning to switch their inhalers without experiencing a gap in coverage. The U.S. is in the thick of viral respiratory season, with the latest data from the CDC showing that the levels of COVID-19, influenza, and RSV are “high” to “very high” in 38 states. People living with persistent asthma may have a higher risk of asthma exacerbation if they get a viral respiratory infection and do not have their maintenance inhaler available.
Although the cost of the generic is lower than branded Flovent, it’s possible that many health insurers may not cover this medication. This means that for insured patients, the authorized generics may be more expensive than other brand-name medications. For example, some United Healthcare plans are preferring Arnuity Ellipta, Asmanex HFA, and QVAR Redihaler instead of generic Flovent. Other insurers may be doing the same. This could create confusion and delays in filling a new prescription for patients. While all of these inhalers are high quality, there may be additional challenges in training patients to learn how to use these other inhalers.
Doctors and insurance companies should reach out to patients who may be affected as soon as possible to inform them of these changes and discuss alternatives to ensure no gaps in access to an inhaler. Patients may not be able to get the authorized generic and may have to use a different type of inhaler. The dosing of the medication may change, and this may affect their health. Doctors and pharmacists should also be prepared to discuss with patients how to use the new inhaler. Patients undergoing an asthma attack cannot afford to wait.
Zachary Rubin, MD, is a pediatrician specializing in allergy and immunology.
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