At the end of 2023, GSK, the manufacturer of some of the most common inhaled steroids and inhalers, discontinued one of its most used medications, Flovent (fluticasone propionate). This caused many of the 24.8 million people living in the U.S. with asthma, including 5.5 million children, to start their year worrying about getting a new controller medication. People with asthma are often treated with a combination of quick-relief (rescue) and long-term maintenance (controller) medicines. Flovent, or Fluticasone propionate, is categorized as an inhaled corticosteroid (ICS) maintenance medicine that works to reduce the underlying inflammation in the airways. So, for many asthma patients, it was the essential daily medication that allowed them to live their lives and help prevent asthma symptoms. As a pediatric pulmonologist at Johns Hopkins Hospital, Dr. Christy Sadreameli wants to help her patients with this difficult transition. She shared her process with us.
Don’t Panic, Talk to Your Doctor
Though pharmacies will soon run out of the medication, patients can still use what they have until it runs out. “It should be made clear that the medication is still safe. There’s nothing wrong with your Flovent, they’re just not going to be making it anymore,” Dr. Sadreameli said. But patients will need to find a controller medication to replace it.
The first most immediate substitution is the authorized generic version of the drug, which is Flovent’s equivalent in every way. This includes metered dose inhaler and dry powder inhaler devices. If your insurance will cover the generic version, you're all set. However, many people’s insurance will not cover the generic. In that situation, your healthcare provider or prescriber will need to help you navigate the other options. “Sometimes I can do a prior authorization and get the medication they need by just filing some paperwork. Other times, it's not that easy,” Dr. Sadreameli said.
“Depending on the patient’s age and the severity of their asthma, we may be able to find other types of inhaled steroid devices that are appropriate for them,” Dr. Sadreameli said. Currently, there are a few other inhaled steroids on the market, which are reasonable substitutes for Flovent (fluticasone propionate).
If these are also not covered by insurance, a dry powder inhaler may be suggested. This option is best for adults or older children with asthma. “Dry powder inhalers aren’t right for everyone because you have to really coordinate your breathing,” Dr. Sadreameli explained. “They don't use a spacer so using one involves putting your lips around it, forming a tight seal, breathing in strongly and holding it for about 10 seconds. As you can imagine, asking a four-year-old to do that properly would be difficult. So as a rule of thumb, I don’t suggest those for anyone under eight, and there are some older patients who are also not able to use them for various reasons.”
Learn more about how to use different asthma medical devices.
Navigating Insurance
Insurance coverage is the big hurdle when finding a new medicine. After talking to your doctor, may need to talk directly to your insurance carrier to determine what coverage, if any, you have for the new medicines, or if you’ll need to have your doctor ask for a prior authorization before the insurer will cover them. Some people with asthma will be easily switched to the generic or one of the substitutions. Alternatively, switching to a dry powder inhaler version of an inhaled steroid may be the only realistic option. “In my practice, though the alternatives will work for most patients, I’m coming up against some issues where patients who may be challenged with proper technique because of weaker muscles, such as older adults and younger children, are not a good candidate for a dry powder inhaler, even if they are older. But it has been a little tricky to work with their insurance to get something more appropriate covered,” Dr. Sadreameli said. “I don't have a perfect solution, but my advice would be to advocate for yourself or your child and work with your healthcare provider closely. We are here to help patients and do whatever we can to make this transition easier.”
Stay Prepared
Asthma is a chronic inflammatory disease of the airways that many people live with all their lives. So, using long-term maintenance medicine is essential to survival. Flovent is not the only asthma medication that has been discontinued in the last few years. That is why you should develop an asthma action plan with your healthcare provider, so that you are prepared to best manage your asthma. The Lung Association’s Asthma and COPD Medication poster is also a good resource as it is updated twice annually and is available for free at Lung.org/asthma/resource-library.
Blog last updated: February 21, 2024
