Medicaid Change Sparks Warning for Children

A switch in Medicaid’s formula could mean many children will go without inhalers in the coming months.

The process change means drugmakers have to pay Medicaid if list prices on older products are higher than current inflation rates. While the change made the most impact on insulin prices, inhalers also are dropping, so companies can get around the new rule.

Already, three of the largest inhaler manufacturers said they’d be capping inhaler co-pays at $35 monthly. That includes Boehringer Ingelheim, AstraZeneca PLC and GlaxoSmithKline for the Advair Diskus and Advair HFA inhalers as well as Symbicort and Spiriva HandiHaler and Atrovent HFA units. The companies have also lowered several list prices in what is good news for patients on a budget.

The companies have not acknowledged the price cuts as a reaction to the new Medicaid rebate update, and some say they are reflective of their desire to reduce barriers of access to lifesaving medications.

“We continually look at market dynamics to assess what more we can do to address barriers to access and affordability of our medicines to help patients living with respiratory diseases lead healthier lives,” an AstraZeneca spokesperson told Roll Call.

Those with asthma and chronic obstructive pulmonary disease (COPD) will be affected by the price cuts, but there’s a dark side to the new guidance.

Drugmaker GlaxoSmithKline has already removed two well-known children’s inhalers, Flovent HFA and Flovent Diskus, while one other option, Organon’s Asmanex, is said to already be facing a shortage.

“It’s difficult to say whether other drug manufacturers will discontinue other inhalers,” Louise Norris, a health policy analyst for healthinsurance.org, told Newsweek. “But from a consumer perspective, the most important point is to ensure continued access to an inhaler that will enable them to properly manage their asthma.”

Newsweek reached out to GlaxoSmithKline for comment via email.

GlaxoSmithKline told Roll Call it had been planning to discontinue the two affected inhalers for a long time.

“The price reductions build on our strong track record of increasing access and improving the affordability of its medicines including an ongoing commitment to responsible pricing,” a company spokesperson said.

Other Changes for Medicaid

This isn’t the only big change potentially coming to Medicaid patients this year.

Republican senators Bill Cassidy of Louisiana, John Cornyn of Texas and Tim Scott of South Carolina, along with Democrats Tom Carper of Delaware, Mark Warner of Virginia and Bob Menendez of New Jersey, proposed the Delivering Unified Access to Lifesaving Services (DUALS) Act of 2024 in hopes of improving Medicare and Medicaid for dual eligibles this month.

If passed, the DUALS Act would require each state to develop a comprehensive and integrated health plan for dual-eligible beneficiaries. This would either move forward as an entirely new system or an addition to existing coverage options.

The changes could impact about 12.2 million low-income or disabled Americans who are jointly enrolled in Medicare and Medicaid.

“Patients dually eligible for Medicare and Medicaid have much worse outcomes than other groups even though there is a lot more money spent on their care,” Cassidy said in a statement. “Making Medicare and Medicaid better work together makes patients healthier and saves money for taxpayers.”