The Asthma Crisis: Youngest Patients Suffer as Preventive Inhalers Become Scarce and Expensive
Kerry Pearl vividly recalls the moment when a pharmacist held up the asthma medication her 4-year-old son needed to help him breathe easier. “He was literally holding it, looking at me like ‘I can’t give you this,’” she recalled. Her young son had been experiencing frequent coughing fits during the night and gasping for breath when speaking, making it evident that his asthma was far from under control. The pharmacist stood between them with the answer to their problem: fluticasone, a preventive medication that helped maintain control of youngest children’s asthma by preventing their airways from swelling. However, the branded version of this drug, Flovent, was removed from the US market by British drug giant GSK earlier this year, leaving only three alternatives for young children with asthma.
Flovent’s replacement, an authorized generic version of the same drug made by Prasco Laboratories, does not have the same level of insurance coverage. With no rebates offered by the manufacturer to lower the net cost, it is significantly more expensive and out of reach for many families. This has forced parents like Kerry Pearl into a frantic search for alternatives to ensure their children can breathe easily.
The need for preventive asthma inhalers is essential, as asthma drugs can be costly across the board. In response to this issue, three major makers of asthma inhalers pledged to cap out-of-pocket costs for some US patients at $35 per month. However, this pledge does not apply to the daily inhalers used by the youngest children with asthma, leaving them vulnerable to asthma flare-ups and visits to the emergency room.
Dr. Robyn Cohen, a pediatric pulmonologist at Boston Medical Center, explained that metered-dose inhalers are the preferred options for young children with asthma. These inhalers require no special breathing techniques and can be used with a spacer, which transforms the medication into an aerosol that little kids can easily inhale through a face mask. However, only three metered-dose inhalers are suitable for young children: fluticasone, budesonide (Pulmicort), and mometasone (Alvesco).
Since the removal of branded Flovent earlier this year, these three options have become increasingly expensive and difficult to find. The authorized generic version of fluticasone is not covered as widely by insurers due to the absence of rebates paid by the manufacturer. Pharmacy benefit managers reported that the authorized generic was more expensive than the branded version, making it an unrealistic solution for many families.
Doctors and parents have been anticipating this issue for months. One proposed solution was to switch children to Asmanex, but that drug is now in shortage as well. The third option, Alvesco, also faces challenges – it carries a higher list price and does not have broad insurance coverage.
Julie Leach’s 13-year-old daughter, Abby, has cerebrocostomandibular syndrome, a rare condition that restricted her lung development. She was doing well on Flovent until it was discontinued. The insurance tangles for these medications can lead families through lengthy and complicated processes to secure the inhalers their children need on a monthly basis. In Abby’s case, her insurance suggested she use Pulmicort instead of the generic Flovent. However, her doctor believed metered dose inhalers with spacers would be more effective for Abby due to her tracheostomy tube. It took weeks to negotiate a solution and secure the medication, leaving Abby without any treatment during that time.
The lack of help for children in securing preventive asthma inhalers is incredibly frustrating for parents like Kerry Pearl and Julie Leach. “I don’t know why we’re treating kids as kind of a lesser population,” Pearl stated. “Kids need to breathe just like adults do.” The situation calls for immediate action from pharmaceutical companies, insurance providers, and policymakers to ensure that the youngest asthma patients have access to affordable and effective preventive treatments.
