Massachusetts families have been facing significant challenges since GlaxoSmithKline (GSK) canceled a widely prescribed children's asthma medication nearly a year ago. As flu and respiratory virus season approaches, this problem takes on renewed urgency. Flovent HFA, GSK's brand name for the discontinued inhaler, has been unavailable since December 2023. In response to new federal price limits, the company introduced an authorized generic version, but this has led to unexpected consequences.

Generic vs. Original: The Cost Dilemma

The generic version of Flovent, which GSK introduced, is generally more expensive and fewer insurers are covering it. This has left families and their doctors in a difficult position. Physicians worry that when insurers revise their covered medication lists for the coming year, families will have to start the search for an appropriate replacement all over again.For example, Dr. Robyn Cohen, associate medical director of asthma initiatives at Boston Medical Center, expressed concern. She said, "January 1, those formulary lists are going to change again, and we don’t know what’s on them. I’m worried we’re going to be back to where we were last year."The root of this distress lies in a 2021 federal initiative aimed at keeping medications affordable. The penalties for price increases outpacing inflation took effect this year, and most companies responded by cutting list prices. GSK, however, substituted Flovent with a generic not subject to the same penalties. Professors at Johns Hopkins estimated that if GSK had simply reduced the price of Flovent, it would have cost at least $30 less than the generic. One reason for this is that the generic doesn't offer the same level of discounts and rebates as Flovent.

Medicaid's Struggle

Senator Elizabeth Warren accused GSK of "price gouging." She argued that the company switched to a generic to avoid federal price controls on medications. This has had a significant impact on Medicaid providers. Without the rebates and discounts that accompanied Flovent, Medicaid administrators, including MassHealth, are now paying about four times more for essentially the same drug.The Johns Hopkins study estimated that switching from Flovent to the licensed generic could add more than half a billion dollars to Medicaid net spending this year. As an example, Hamilton O’Rourke, a 10-year-old from Acton, saw his care suffer after the switch. His mother, Sarah O’Rourke, had to go through a long process to get coverage for alternative medications.

Alternatives and Their Challenges

Flovent was one of the most commonly prescribed pediatric asthma treatments due to its design for young children's small lungs. However, alternate medications like Asmanex and Symbicort are either in short supply or more difficult to get covered by insurers.For instance, Hamilton O’Rourke was initially prescribed Symbicort as a Flovent replacement, but in 2024, it was no longer included in his insurer's formulary. His mother and doctor had to go through numerous calls and efforts to get coverage. Even then, she had to take additional steps to avoid high pharmacy costs.An October review of hospital admissions data shows a rise in pediatric asthma-related hospital cases following the withdrawal of Flovent. In the second quarter of this year, hospital admissions for asthma-related complications among children prescribed fluticasone propionate increased by 24 percent compared to the same periods in 2022 and 2023. Intensive care unit admissions also increased more than 21 percent.Dr. Timothy Lax, a physician with Central Mass Allergy & Asthma Care in Worcester, expressed frustration. He said, "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, which were more severe than before. His mother said, "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 now has enough Symbicort to get her son through March or April, but she is uncertain about the future. She said, "I don’t know if we’re going to have to go through this again next year. I’m guessing we will."Jason Laughlin can be reached at jason.laughlin@globe.com. Follow him @jasmlaughlin.