Increasing Pharmaceutical Copayments: Impact on Asthma Medication Utilization and Outcomes
University of Colorado School of Pharmacy, Mail Stop C238, Pharmacy and Pharmaceutical Sciences Bldg, 12850 E Montview Blvd, Aurora, CO 80045. E-mail: . The American journal of managed care
(Impact Factor: 2.26).
Objectives: Unintended consequences may result from changes in pharmacy benefit design. The objective was to determine the impact of increasing patient prescription copayments for guidelinerecommended, long-term asthma controller (LTC) medications on asthma-related medication use and healthcare services. Study Design: We used 2005 MarketScan healthcare and pharmacy claims data to identify asthma (International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM] diagnosis code 493.xx) patients aged 12 to 64 years who were continuously enrolled through 2006 with >1 claim for an asthma medication in 2005. LTCs included: inhaled corticosteroid (ICS) (n = 10,251), ICS plus long-acting beta agonist (COMBO) (n = 27,407), and leukotriene receptor antagonist (LTRA) (n = 20,664). Methods: Using multivariable models, we estimated the associations between changes in LTC copayments and LTC consumption and asthmarelated outpatient and emergency department (ED) visits. Results: Patients were dichotomized into >$5 average increase in patient copayments per month of medication supplied (yes/no). The mean annual change (2005-2006) in copayments per month was $13.23 versus -$3.88 (ICS), $11.76 versus -$3.06 (COMBO), and $9.78 versus -$2.06 (LTRA). The >$5 group experienced a significant decline in average annual days of medication supplied of -47.1 days of ICS (95% CI -43.5 to -50.8), -35.3 days of COMBO (-32.4 to -38.2), and -47.5 days of LTRA (-43.2 to -51.7). Among COMBO and LTRA medication users, the >$5 copayment increase was associated with more asthma-related outpatient visits and ED visits compared with the <$5 group. Conclusions: The findings suggest that even small changes in average copayment for asthma medications can result in significant reductions in medication use and\ unintended increases in healthcare services.
Available from: Laura S Gold
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ABSTRACT: Despite effective medications, asthma remains a significant burden to the US health care system.
To determine whether partly and uncontrolled asthma in respondents to the Asthma Insights and Management (AIM) survey was associated with adverse outcomes (such as visits to health care professionals and medication use) compared with well-controlled asthma.
The AIM survey, conducted in 2009, included 2,500 patients with asthma who were 12 years or older. We classified patients into levels of control and compared use of health care services and limitations of activities in patients whose asthma was well controlled vs those with partly and uncontrolled asthma.
Patients who reported lower income and educational status and lacked health insurance were less likely to have had well-controlled asthma. Respondents with uncontrolled asthma were more likely to report ever use of oral steroids (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.9-3.2) and over-the-counter medicine (OR, 2.7; 95% CI, 2.0-3.7) compared with patients whose asthma was well controlled. Respondents with partly and uncontrolled asthma were also significantly more likely to report ever visiting physicians, specialists, or the emergency department or being hospitalized for asthma compared with those whose asthma was well controlled (ORs ranging from 2.1 to 5.6). Finally, respondents whose asthma was uncontrolled had increased odds (ORs ranging from 14 to 34) of reporting that asthma limited their activities compared with respondents whose asthma was well controlled.
Patients with partly and uncontrolled asthma defined by international guidelines reported use of significantly more health care resources and greater limitations of their daily activities compared with patients whose asthma was well controlled.
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ABSTRACT: Background and objectives:
Medication use-related issues remain problematic in childhood asthma despite effective treatment strategies and public investment into improved asthma management strategies in industrialized countries. This study aimed to carry out an in-depth exploration of the views of parents/carers and children with asthma on medication use.
Semi-structured qualitative interviews were conducted with a purposive convenience sample of children with asthma and their parents recruited from general practices in Sydney. Interviews were tape-recorded, transcribed verbatim, and thematically analyzed.
A total of 52 interviews (26 parents/carers and 26 children with asthma) were conducted. Major themes which emerged from the children's interviews included issues such as self-image, resistance to medication use, and lack of responsibility in medication taking. Parental or carer issues included lack of clear understanding of how medications worked, as well as administration difficulties, cost constraints, and beliefs about medications contrary to quality use.
This is one of the few research studies exploring the viewpoint of children with asthma about their medications in Australia. Despite investment in dissemination of professional, targeted evidence-based asthma management strategies in healthcare, there seems to be a lack of depth in terms of what parents understand about their child's asthma. Effective communication about medication usage, especially the inclusion of the child in the consultation to empower them to be involved in their own asthma care, may be the answer.
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Asthma medication adherence is related to better asthma outcomes, but identification of suboptimal patient adherence behavior is not standardized in clinical settings.
The purpose of this study was to develop a practical questionnaire that reflects nonadherence risk and identifies potential adherence barriers.
A questionnaire that included 20 potential adherence questions was completed by 420 adult patients with asthma who filled a prescription for an inhaled corticosteroid (ICS) and a short-acting beta agonist (SABA) in the previous 6 months. Questions without substantial floor or ceiling effects that were significantly related to self-reported low adherence or previous ICS canister dispensings were identified. Internal consistency reliability was tested by Cronbach α. Relationships of these questions to Asthma Control Test scores, future percent of days covered for ICS dispensings, and future asthma exacerbations and SABA dispensings were determined.
Five final questions were identified: following “my medication plan,” forgetting, not “needing” the medications, side effects, and cost. Low internal consistency reliability (<0.50) suggested items should not be summarized by a single score. All five questions were related to Asthma Control Test scores. Following the medication plan, forgetting, and not needing medication were significantly related to prospective percent of days covered. Side effects were related to subsequent SABA and oral corticosteroid dispensings, and cost was significantly related to oral corticosteroid dispensings.
We identified five questions related to other measures of adherence and to asthma control that can be used clinically to identify patients at risk of nonadherence and the specific adherence barriers involved.
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