On January 23, 2024, officials from the U.S. Department of Health and Human Services (HHS) engaged in discussions with various stakeholders to address the nationwide accessibility of medications crucial for managing pediatric conditions like asthma and eosinophilic esophagitis. Representatives from leading patient advocacy organizations, provider groups, and health insurers convened with HHS, including individuals from the Centers for Medicare & Medicaid Services (CMS), to deliberate on viable solutions.
Access Challenges and Stakeholder Concerns
The meeting shed light on the challenges faced by patients, parents, doctors, and pharmacists across the nation in accessing specific inhaler types and medications tailored for children under the age of 12 with asthma, as well as individuals with eosinophilic esophagitis. The discontinuation of Glaxo Smith Kline's Flovent HFA inhaler earlier in 2024, replaced by an authorized generic, posed hurdles as many pharmacy benefit managers (PBMs) did not accord preferred placement to the generic in their formularies. Consequently, stakeholders expressed concerns regarding the effectiveness of drug delivery for children and individuals with specific medical conditions, emphasizing the importance of the right inhaler type.
Initiating Solutions and Collaboration
HHS and CMS officials, in response to the highlighted access challenges, have been actively engaging with state Medicaid programs, health plans, providers, and families. The meeting provided a platform to deliberate on the encountered access issues, including parental confusion at pharmacy counters and the high out-of-pocket costs associated with authorized alternatives to Flovent. Moreover, concerns were raised regarding drug companies' decisions to discontinue products rather than adjusting prices, impacting patients. HHS and CMS initiated discussions with stakeholders to identify and implement solutions aimed at eliminating access barriers, ensuring seamless access to authorized generics or suitable substitutes.
Commitment to Collaboration and Equitable Access
The conclusion of the meeting underscored HHS's commitment to ongoing collaboration with leading patient advocacy organizations, provider groups, and health insurers. Emphasizing the imperative of equitable access to critical medications, HHS reiterated its dedication to developing additional solutions and mitigating access challenges in partnership with stakeholders.
Highlights
- Stakeholders convened to address nationwide accessibility of pediatric medications for conditions like asthma and eosinophilic esophagitis.
- Challenges included the discontinuation of Flovent HFA inhaler and the lack of preferred placement for its authorized generic in PBMs' formularies.
- Concerns raised encompassed parental confusion at pharmacy counters, high out-of-pocket costs, and the impact of drug companies' decisions on patients.
- HHS and CMS initiated discussions with stakeholders to identify solutions and ensure equitable access to critical medications.
- Commitment was reiterated to continue collaboration with stakeholders to develop additional solutions and mitigate access challenges.
