Utilization Increases and Spending Decreases With Preventive Drug Lists for Asthma Medications

Reducing cost-sharing for asthma medications through a preventive drug list (PDL) increases adherence to controller medications, according to a study published in JAMA Network Open.

“In this study, we analyze whether a PDL that includes asthma controller and rescue medications is associated with improved adherence to controller medications, reduced adverse health outcomes, and reduced patient OOP spending among commercially insured patients with asthma enrolled in these plans overall and for lower-income subgroups,” explained corresponding author Anna Sinaiko, PhD, Department of Health Policy & Management, Harvard T.H. Chan School of Publish Health in Boston, MA, and coauthors.

Among the 12,174 participants included in the analysis, 6087 were enrolled in the PDL group, and 6087 were enrolled in the control group. Patients who received a PDL experienced a reduction in annual out-of-pocket (OOP) expenses for their asthma care compared to patients in the control group. This included a decrease in spending for all asthma medications combined (by $28 [95% CI, -$37 to -$18] per member; relative change, -32.4%) and for all asthma care (by $34 [95% CI, -$47 to -$21] per member; relative change, -28.4%). Additionally, OOP spending was significantly lower for LTI medications (by $6 [95% CI, -$9 to -$3] per member; relative change, -36.9%) and for albuterol inhalers (by $8 [95% CI, -$10 to -$5] per member; relative change, -36.0%).

In comparison to the control group, the PDL group experienced significant annual increases in 30-day fill rates for inhaled corticosteroid long-acting β2-agonist (ICS-LABA) (0.06 [95% CI, 0.01 to 0.10] fills per member; relative change, 25.4%) and any controller (0.10 [95% CI, 0.03 to 0.17] fills per member; relative change, 12.9%). For controller users, the 30-day fill rates increased for ICS-LABA (0.25 [95% CI, 06 to 0.44] fills per member; relative change, 24.6%) and any controller (0.42 [95% CI, 0.07 to 0.78] fills per member; relative change, 11.6%) compared with earlier records. Furthermore, there was a considerable increase in PDC for ICS-LABA (absolute change, 6.0% [95% CI, 0.7% to 11.3%]; relative change, 15.6%).

“This case-control study found that exempting asthma medications from the deductible through PDLs was associated with a modest absolute increase in adherence to controller medications, particularly ICS-LABA, for which we found a 25% relative increase in fills,” wrote the study authors. “Access to the PDL also was associated with significantly reduced OOP spending on asthma care,” they added.

Reference

Sinaiko AD, Ross-Degnan D, Wharam JF, et al. Utilization and spending with preventive drug lists for asthma medications in high-deductible health plans. JAMA Netw Open. 2023;6(8):e2331259. doi:10.1001/jamanetworkopen.2023.31259