Docs, parents, face turmoil in wake of asthma drug’s cancellation
“January 1, those formulary lists are going to change again, and we don’t know what’s on them,” said Dr. Robyn Cohen, associate medical director of asthma initiatives at Boston Medical Center. “I’m worried we’re going to be back to where we were last year.”
The root of families’ distress is a 2021 federal initiative intended to keep medications affordable by adding penalties when a drug’s price increase outpaces inflation. The penalties went into effect at the beginning of this year. Most companies responded by cutting their drug’s list prices. GSK instead subbed out Flovent for the generic, which is not subject to the same penalties. (GSK also said it had for some time intended to discontinue Flovent.)
Professors at Johns Hopkins estimated in a study in November that if GSK had simply reduced the price of Flovent to avoid the new federal penalties, it would have cost at least $30 less than the generic, around $150 compared to the authorized average sale price for the generic of almost $184. One reason is the generic doesn’t come with the same level of discounts and rebates that insurers got for Flovent.
The Massachusetts Department of Public Health issued an advisory in November that described GSK’s decision to discontinue Flovent as an additional barrier to people already struggling to access health care.
Senator Elizabeth Warren accused GSK of “price gouging,” arguing the company switched to a generic as a way to avoid federal price controls on medications. The switch has hammered Medicaid providers, Warren said. Without the rebates and discounts that accompanied Flovent, Medicaid administrators, including MassHealth, are now paying about four times more for essentially the same drug, according to a letter Warren sent Wednesday to GSK chief executive Emma Walmsley.
The Johns Hopkins study estimated switching from Flovent to the licensed generic could add more than half a billion dollars to Medicaid net spending this year.
“GSK’s actions appear to be intended to circumvent new provisions passed by Congress to hold drug manufacturers accountable for years of historical price increases,” Warren wrote.
The British company reported operating profit of more than $8 billion in 2023.
Flovent was manufactured by a second company, Prasco Laboratories, under a license from GSK. A spokesperson for GSK deferred comment to Prasco, which did not respond to a call for comment.
Warren’s letter also castigated the company for failing to respond to requests for detailed information about the profit sharing between GSK and the manufacturer.
“It’s shameless of the company to point fingers and try to shift the blame while kids across the country are suffering at the hands of clear, indisputable corporate greed,” Warren said in a statement Friday.
Flovent, a corticosteroid treatment now sold under its generic name fluticasone propionate, was one of the most commonly prescribed pediatric asthma treatments, in particular because the inhaler used to deliver the medication was designed for young children’s small lungs. Alternate medications, such as Asmanex and Symbicort, are either in short supply or more difficult to get covered by insurers.
Other pharmaceutical companies have yet to follow GSK’s example, said Jeromie Ballreich, an associate research professor at Johns Hopkins’s Bloomberg School of Public Health and an author of the report on Flovent, probably due to the bad publicity the move attracted. It is an open question though, he said, whether such maneuvers could become more common under the incoming Trump administration. Some of Trump’s nominees, including Robert F, Kennedy Jr., are critical of big pharma. Others are likely to be more pro-business and anti-regulation.
“I don’t know how that increasing regulation, increasing pressure against pharma versus less pressure against pharma, is going to play out,” Ballreich said. “It’s a very cloudy crystal ball.”
Hamilton O’Rourke, of Acton, is one of many whose care has suffered since the switch. Until last year, the 10-year-old routinely received prescriptions for Flovent. Near the end of 2023, his mother, Sarah O’Rourke, got her insurance company to cover a prescription for Symbicort as a Flovent replacement. In 2024, though, that drug was no longer included in the insurer’s formulary.
For months, she and her son’s doctor, Ben Nelson of Massachusetts General Hospital, exchanged calls with her insurer, trying to get coverage for the boy’s prescription. Her son attempted to use a powdered medication that didn’t work before the insurer relented in November and covered Symbicort. Even then, she had to sign up with a mail delivery company to avoid being charged $425 at her local pharmacy and still ended up paying out-of-pocket for an air chamber to help direct the medication into Hamilton’s lungs.
The scramble for alternative asthma treatments puts significant demands on his staff, Nelson, a pediatric pulmonologist, said.
“If I’m worried about a delay getting their medicine, then I have to prescribe a secondary medicine and also have prednisone on hand, give them a script [for prednisone] for them to avoid the ER or the hospital,” he said.
An October review of hospital admissions data by a medical industry researcher points to a rise in pediatric asthma-related hospital cases following the withdrawal of Flovent. In the second quarter of this year, hospital admissions nationally for asthma-related complications among children prescribed some version of fluticasone propionate, including Flovent in earlier years, increased 24 percent compared to the same periods in 2022 and 2023, according to Epic Research, the public research branch of a medical software company. Intensive care unit admissions increased more than 21 percent in the same span.
“It’s very frustrating,” said Dr. Timothy Lax, a physician with Central Mass Allergy & Asthma Care in Worcester. “Especially during the winter when there are a lot of environmental components that can contribute to their conditions, it’s really important for them to have their inhalers.”
Three times this year, Hamilton had asthma flare-ups, dry coughing severe enough to make him vomit. When he was on Flovent, attacks that serious typically happened just once a year.
“They think they’re saving money, but what they’re making people do is making people go to the emergency room because their kids can’t breathe,” Sarah O’Rourke said.
O’Rourke now has enough Symbicort to get her son through March or April, she said. She is hoping for the best after that.
“I don’t know if we’re going to have to go through this again next year,” she said. “I’m guessing we will.”
Jason Laughlin can be reached at jason.laughlin@globe.com. Follow him @jasmlaughlin.
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