More children stopped using steroid inhalers to control their asthma after a manufacturer discontinued a popular inhaler, a new study says.

In 2024, GlaxoSmithKline withdrew Flovent from the market. The inhaler was commonly prescribed to prevent asthma attacks in children.

The pharma company continued to sell a chemically identical “authorized generic,” but some families reportedly had trouble getting this drug because their insurance either didn’t cover it or required higher out-of-pocket costs, researchers reported April 26 in the Journal of the American Medical Association.

As a result, children were 6 percentage points more likely to have no steroid inhaler in hand to prevent an asthma attack, results show.

Asthma inhaler access dropped from nearly 41% to nearly 35% between 2021 and 2023 among patients 18 and younger prescribed Flovent (fluticasone), researchers found.

By comparison, young asthma patients prescribed other inhaled steroids had about the same access to an inhaler, at a consistent level around 38%, results show.

“Our findings suggest the withdrawal of Flovent disrupted inhaled steroid therapy in children, potentially increasing their risk of asthma attacks,” lead researcher Dr. Kao-Ping Chua, a pediatrician at the University of Michigan Health C.S. Mott Children's Hospital, said in a news release.

Researchers said Flovent was likely pulled from the market due to changes in rebates that manufacturers must pay to Medicaid programs to obtain drug coverage.

Historically, these rebates were capped, but the American Rescue Plan Act of 2021 eliminated this cap in January 2024, researchers said.

Eliminating the cap would have resulted in rebates that exceeded Flovent’s sales price because GSK had previously increased the drug’s price rapidly, researchers said. That exposed them to a rebate that applies when increases in a drug’s price outpaces inflation.

“Our findings suggest that the elimination of the Medicaid rebate cap had unintended consequences for children with asthma,” Chua said.

He noted that other drugs also have triggered the rebate cap, including meds for diabetes and infections.

“If other brand name drugs are withdrawn due to elimination of the rebate cap, policymakers should proactively implement interventions to prevent therapy disruptions, such as ensuring insurer coverage of alternative drugs,” Chua said.

More information

KFF has more on the elimination of the Medicaid prescription drug rebate cap.

SOURCE: University of Michigan, news release, April 26, 2025