Q&A: Asthma patients have options as GSK moves Flovent to generic production

Key takeaways:

• GSK has halted the Flovent brand, but generic versions will be available.
• Not all insurance plans cover the generic versions yet.
• Other inhalers are available, but proper use may be an issue.

GSK has stopped manufacturing its Flovent HFA and Flovent Diskus fluticasone propionate inhalers for asthma and has made authorized identical generic versions of these devices available instead.

Healio spoke with Angela Duff Hogan, MD, FAAAAI, FACAAI, FAAP, chair of the asthma committee of the American College of Allergy, Asthma and Immunology, to find out more about this change and how it will impact patients.

Hogan also is professor of pediatrics at Eastern Virginia Medical School as well as an allergist and immunologist with the Children’s Specialty Group at the Children’s Hospital of the King’s Daughters.

Healio: Are your patients aware of this change?

Hogan: While the generic for Flovent was released to the market in July 2023, notifications from different insurance companies started to surface in late October. In the last week, my practice has had more than 100 phone calls, faxes and portal messages requesting approval for the generic Flovent or switching to another covered maintenance asthma medication.

Many providers are just being notified about the discontinuation of the brand Flovent, so I am sure that patients were not readily aware of these changes either. In Virginia, there was a scramble in mid-December to get generic Flovent added to the state Medicaid formulary, as only Flovent was there previously.

Healio: Do you expect this change to offer any advantages for your patients?

Hogan: Generic medications are pharmaceuticals with the same therapeutic properties as an original off-patent drug. Typically, they are sold at a discounted price compared with the brand medication. However, if the insurance plan has yet to approve the generic form of the medication, its cost will be higher.

Healio: Do you expect this change to cause any problems for your patients?

Hogan: There could be a lag time with patients getting new medications, either the generic or having to switch to a completely different maintenance medication. Patients may have a period where they do not have maintenance medications. During the cold and flu season, this would not be the optimal time to miss their daily asthma medications, as this could lead to an asthma flare.

Healio: If patients are unable to access the generic versions, what options do they have?

Hogan: There are other maintenance steroids available on the market. A problem is the age at which these medications have been FDA-approved and whether the devices are something that a child will be able to use effectively.

In children aged 0 to 4 years, nebulized budesonide suspension is the only approved comparable inhaled corticosteroid. Many families in this age group do not have a nebulizer and have been taught to use hydrofluoroalkane (HFA) and a spacer with their fluticasone and albuterol.

Qvar Redihaler (beclomethasone HFA, Teva) has been approved in children aged 4 years and older. This device, however, requires some skill and cannot be used with a holding chamber device.

The Asmanex Twisthaler (mometasone furoate, Organon) for children aged 5 years and older and Pulmicort Flexhaler (budesonide, Cheplapharm) for children aged 6 years and older require users to close their mouth around the mouthpiece and take in a fast, deep breath, which can be developmentally very challenging for younger patients and impossible for patients with developmental disabilities.

Mometasone HFA can be used with a holding chamber and is approved for patients aged 5 years and older.

Patients could also be switched to single maintenance and reliever therapy (SMART) or MART therapy as per the Global Initiative for Asthma or National Heart, Lung, and Blood Institute asthma guidelines, but this could also pose difficulties with insurance coverage.

There are also apps and coupons for many medications that can also track and reduce prescription costs.

Healio: Do you have any concerns that these options will not perform as well as Flovent?

Hogan: For the most part, inhaled corticosteroids are interchangeable with appropriate dose adjustments. However, I am concerned that patients learn the names and indications for each asthma medication. They also need to know how to use their medication’s device.

Healio: Do you have any recommendations for physicians to help them help their patients navigate these changes?

Hogan: Ideally, patients who have concerns about techniques would be able to have a timely follow-up asthma visit for education. There are videos available online that demonstrate how each asthma device works.

I also hope pharmacists continue to ask patients about their knowledge of using new asthma medications. As medication changes occur, new asthma action plans could be provided to each patient. If there is a lag time in getting their maintenance medication and they begin having asthma symptoms, it would be essential for them to speak with their asthma provider right away.

For more information:

Angela Duff Hogan, MD, FAAAAI, FACAAI, FAAP, can be reached at angela.hogan@chkd.org.