United States: One of the most frequently prescribed medications for children in the US asthma treatment is Flovent; however, it is no longer manufactured in the US.

However, it is no longer manufactured in the US. Just the month before, on 1 January, the pharmaceutical company, GSK, took it off the shelves and replaced it with a generic version identical to this one, fluticasone.

Flovent, like other generics in this category, is an asthma medication named a controller. They function by inhibiting inflammation of the airways of children with asthma that puts them at the risk of getting flare-ups — having an asthma attack — when exposed to triggers.

Children with severe cases of asthma – for them the medication is a lifesaving treatment, as CNN Health reported.

An Example of an asthmatic patient

Four-year-old Bryce Cohen is one of those kids. It was when he was only 8 months, he first went into the pediatric ICU to have difficulty breathing.

Two months later, he was hospitalized for the second time. In the years that have passed, he has never been hospitalized, a feat that he can largely credit to Flovent.

His asthma has flared up only one time: the previous summer when his family and the physicians tried to give him a break from the daily inhaler – he had a common cold.

Bryce is a resident of New York City, and he is a patient at the Columbia University Irving Medical Center. The family of my patient has not been successful in obtaining the new generic version of Flovent in the last thirty days.

Bryce’s mom, Rebecca Baye Cohen said, “This is a really big issue, and it’s scary to think that we are in the middle of the cold season,” as reported by CNN Health.

Additional problems faced by asthma medication buyers

Visual Representation – Asthma Medication. Credit | Getty images

Even some physicians in the country are facing problems of not getting their patients’ asthma medicines.

The reason – The generics of GSK are not covered by their insurance plan and they might have to try other medicines that may not be effective or are short in supply.

CNN has reported that doctors warned about the upcoming change in prescriptions and coverage during its December coverage. The spokesperson of GSK said the company was shifting from Flovent to fluticasone “as part of our commitment to be ambitious for patients,” adding that the generic would “provide patients in the US with potentially lower cost alternatives of these medically important products.”

The experts who track the industry, in their turn, noticed that the switch happened exactly at that time the provision in the 2021 American Rescue Plan Act went into effect.

And, this is, rebates for Medicaid rebates would have caused GSK to pay large penalties, following the increases of the Flovent rate at a rate higher than inflation for years.

The penalties would have produced the rebates to Medicaid above the price of the drug, thereby Flovent would have to be sold to Medicaid at a loss.

The approved generic equivalent, fluticasone, would be the same, but without the branding and history of constant price increases, which would give the medicine being exposed to large rebates to Medicaid.

Andrew Baum, an analyst who covers the stock of GSK and other pharmaceutical companies for the financial firm Citi said, “Obviously, Pharma doesn’t want to be selling at a loss on anything in its portfolio,” and, “So it seeks to evade impact by, one: discontinuation; two: authorized generic,” as CNN Health reported.

Moreover, Dr. Stephanie Lovinsky-Desir, chief of the Division of Pulmonology at Columbia University Irving Medical Center said the substitution of one medication with another “seems like it should be great,” and, “The problem is that insurance companies have not listed fluticasone as the preferred medication on their formularies.”

Insurance formularies are a list of prescription drugs, that are covered by specific insurance plans under two criteria, which are in terms of how legit it is used for a certain condition and also how costly it is.

If the medication is not on the formulary, providers must submit for prior authorization approval which means that the patient has to pay out-of-pocket.

Victoria Piane, a pediatric nurse practitioner at Columbia University Irving Medical Center who said her team has been receiving 10 to 15 requests per day for prior authorizations from local pharmacies for the Flovent generic and age-appropriate medications not listed as preferred said, “It’s all a big game,” as CNN Health reported.

Alternative medications in the market

Part of the medications added to the formulary are not clinically fit for children, she noted.

But delivering a dose of the drug by using the generic inhalers And Flovent only takes around a minute or two while the commonly listed options such as dry powder inhalers and breath-actuated pumps require the administrator to give the child deep breaths for at least ten seconds making it impossible for young children to do.

The sprays from the nebulizer are an alternate solution; however, for young children, it means clocking ten to fifteen minutes, every day, twice a day!, said Lovinsky-Desir, as CNN Health reported.

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