Albuterol HFA, and Proventil/Ventolin substitutions

A recent entry by #1 Dinosaur on albuterol HFA formulations got me thinking. We’ve been substituting Ventolin HFA and Proventil HFA for Ivax’s ProAir HFA.

Unfortunately ProAir HFA isn’t substitutable… up until about a year ago, ProAir HFA was called Albuterol HFA — a clever marketing trick meant to confuse pharmacists into thinking that it’s a generic drug rather than a trademarked trade name. (Note the capital A!) The name change to ProAir (same NDC, btw) hasn’t done much to change the perception. Pharmacy people are a wily bunch — names get changed for pointless reasons quite often, so changing a product’s name effectively means nil.

This has created a beneficial situation for Teva/Ivax: because — fairly or unfairly — ProAir is now associated with “generic” albuterol HFA, pharmacists and technicians will reach for the ProAir before they reach for anything else. If a doc writes “albuterol HFA,” I’m going to reach for the ProAir HFA, even though Ventolin HFA might be the same price, because the two are inextricably linked in my mind now, and until I have a reason to change this — taste or whatever — it’s going to be the preferred drug by default.

I’ve surveyed about half a dozen pharmacists over the last week, and only one of them knew that ProAir HFA cannot be substituted for Ventolin or Proventil. So here’s my PSA to you pharmacy types who, like me, didn’t know until recently. You can’t substitute ProAir HFA for Proventil HFA or Ventolin HFA. Nor would you necessarily want to, as copayments are typically Tier 2.

I’m fairly apathetic about the environmental issues involved with CFCs; I’m more concerned about the impact on copayments, and doing the right thing. As of December 2008, all MDIs with CFCs must be withdrawn from the market, as per the FDA.

Copayments and NDAs

Teva/Ivax IS a generic drugmaker, you’re right. However, when they created their Albuterol HFA formulation — notice the capital A, here — they didn’t file an Abbreviated NDA (ANDA) which is required for generic drugs. They filed a full-blown NDA. NDA are used for brand-name drugs. So why did they do it?

I’m speculating here, but I suspect that Ivax saw their time running out on CFC albuterol and decided to work on an HFA-based version in the meantime. However, both Ventolin HFA and Proventil HFA are new drugs. As, of course, is ProAir HFA — which now controls about 60% of the non-CFC ALH market. I wonder how much of this is due to incorrectly substituting ProAir HFA?

  • Ventolin HFA: April 19, 2001
  • Proventil HFA: August 15, 1996
  • ProAir HFA: October 29, 2004

This means that the soonest you’ll see a generic albuterol HFA — no capital a! — is, I believe, sometime in 2010. (If anyone wants to clarify that for me, I would appreciate it.)

Unfortunately, it looks like there’s going to be about two years where patients will have to pay brand-name copays for their MDIs, because ProAir is a brand-name drug on every insurance plan I’ve tried it on. (Yes, I was wrong in my comments on Dr. Dino’s entry.)

When Proventil HFA’s patent expires, I wonder if Teva/Ivax will have a generic form of their albuterol HFA inhaler already lined up? Will it cannibalize their profits in the short-term but create a long-term win? I do know that they’ve certainly captured mindshare with their clever early naming and then the name-change.

For doctors

If you’re a physician, and you want to prescribe an albuterol MDI, don’t specify which brand name you want. Let the patient’s insurer decide. This will save you phonecalls that go something like “Mrs Jones’s insurer will only cover Ventolin HFA or ProAir HFA, but you’ve written Proventil HFA. Can we switch?”

What a pointless waste of time that is for everyone involved, but unfortunately it’s necessary for legal purposes. Unless you get a pharmacist who’s tired of the bologna and simply does the switch automatically because they couldn’t be arsed to waste 30 minutes of their time on the phone to be told what they already know is going to happen.

Tired of all the “HFA”? Technically “HFA” is part of the trade name. Sort of like “OTC” is a necessary part of the “Prilosec OTC” name because it’s not the same as Prilosec for legal purposes. Gah!

58 thoughts on “Albuterol HFA, and Proventil/Ventolin substitutions

  1. If it were me, I would call my insurance company, or check their formulary online to see which one they prefer and request that one instead. It’ll probably end up being ProAir. They’re all equally effective.

  2. After reading pro’s and con’s of pro-air, all I can say is if pro-air works for you, your condition must not be too bad. If you have copd – emphysema, pro-air is dangerous and worthless. All of the hfa type do are NOT as effective as the cfc albuterol. My own experience is that Ventolin comes close to the cfc type. AS far as cost goes, I can get Ventolin for $3.15 at an overseas pharmacy. The U.S. pharmacies are out to make a bundle of money and care less if their products are satisfying their consumers. The air pollution scare that led to the hfa inhalers is part of the global warming B.S.that is being jammed down our throats. i am patiently waiting for sensibility on this matter to change before it’s too late for copd sufferers like me.

  3. Thanks for the quick reply, RJS.

    Going through my leftover inhalers, I discovered that I had used Proventil before! This was prescribed by my doctor who gave me Combivent when I complained that Proventil did not do much for me. He prescribed both on an as need basis.

    That was about a year ago. Now my new doctor prescribes Ventolin which is the same as Proventil and ProAir to supplement Combivent. I’m really lost here. What do you think is going on?

    I am going to talk to my doctor about this on my next visit.

  4. Combivent and albuterol are often used in conjunction with one another. They accomplish the same thing (bronchodilation), but work in different ways. They complement each other in individuals where one or the other does not work alone. In fact, there is a product which combines the two, but it’s only for use in nebulizers (DuoNeb).

    Most physicians use albuterol first, with Combivent as a backup. Albuterol is a first-line agent for bronchoconstriction. In general it’s cheaper. In the future, you could ask your physician to write for “albuterol MDI” rather than a specific brand (Proventil, Ventolin, ProAir). This leaves it open for the pharmacy to choose the product that’s the least expensive for you.

    If you find you need it more often, you may wish to ask your physician about an inhaled corticosteroid (Advair or similar). The other option is to improve the air quality of your environment. Cold, dry air often aggravates COPD, asthma, and other pulmonary conditions. A humidifier does wonders. I spent a little extra money and got one with a built-in hygrometer so it doesn’t run constantly. The humidifiers you find at pharmacies are absolute junk. You’re better off going to Walmart, Target, or similar big box store and getting a larger unit and putting it into a part of your home where the moisture will propagate to a large area easily. (As opposed to just having one in your bedroom.)

  5.  There are so little cfc in the inhaler it makes no difference but now since there is no generic in HFA I have to pay 50 damn dollars for an inhaler because of crappy insurance that only covers generics.

  6. Call your insurance company (or check their formulary online) to see if there are any HFA formulations that they prefer. Usually they have one that’s less expensive than the rest.

  7. Thanks for the info. My mother was just switched from ventonlin to pro air which loops like it’s the same just a different name. Any other options to get the same effect

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