Association of Nonmedical Switches in Inhaled Respiratory Medications with Disruptions in Care: A Retrospective Prescription Claims Database Analysis.

Ileen Gilbert,Katie Devane,Laren Tan,Aanam Aslam Mahmood

doi:10.1007/s41030-021-00147-8

Abstract

IntroductionThere are limited data on the effects of forced medication switching for a nonmedical reason in patients with obstructive airway conditions. This study evaluated disruption in care resulting from a nonmedical medication switch for patients with asthma and/or chronic obstructive pulmonary disease who previously received the inhaled corticosteroid/long-acting β2-agonist budesonide/formoterol.MethodsThis retrospective pharmacy benefit prescription claims analysis evaluated Medicare Part D patients who filled a prescription for budesonide/formoterol as their last inhaled corticosteroid/long-acting β2-agonist in 2016 and were affected by a formulary block of budesonide/formoterol in 2017. Changes to respiratory maintenance therapy, length of gaps in care during which a patient was not in possession of a respiratory controller medication, acute medication use indicative of disease exacerbations, and medication adherence were assessed.ResultsA total of 42,553 patients were included in the analysis. Following the formulary block, 30,016 patients (71%) switched to another controller; 20,628 of these patients (69%) switched to a new inhaled corticosteroid/long-acting β2-agonist, 7081 (23%) stepped down to a monotherapy, and 2307 (8%) switched to a non-inhaled corticosteroid-containing controller. Despite the formulary block, 22,903 patients (54%) attempted to fill budesonide/formoterol as their first postblock controller, and 6624 patients (16%) attempted to return to budesonide/formoterol after switching to another controller. On average, patients experienced a gap in care of approximately 4 months without a controller medication. Also, 9674 (23%) did not fill any controller over the 1-year postblock period. Of those patients who experienced a gap in care, 14,926 (47%) filled a prescription indicative of a possible exacerbation during the gap period (i.e., oral corticosteroids for patients with asthma and oral corticosteroids and/or antibiotics for patients with chronic obstructive pulmonary disease).ConclusionsThe Medicare Part D formulary block was associated with disruption in the management of patients’ respiratory conditions and may have adversely impacted disease control.Supplementary InformationThe online version contains supplementary material available at 10.1007/s41030-021-00147-8.

Highlights

There are limited data on the effects of forced medication switching for a nonmedical reason in patients with obstructive airway conditions
Nonmedical medication switches are challenging for patients with asthma and chronic obstructive pulmonary disease (COPD), as specific drug properties and inhaler devices differ among similar agents [12, 13]
International Classification of Diseases (ICD)-9/10 codes used to identify patients with asthma and/or COPD are described in Table S1 and Table S2 in the electronic supplementary material

Summary

Introduction

There are limited data on the effects of forced medication switching for a nonmedical reason in patients with obstructive airway conditions. This study evaluated disruption in care resulting from a nonmedical medication switch for patients with asthma and/or chronic obstructive pulmonary disease who previously received the inhaled corticosteroid/long-acting b2-agonist budesonide/ for moterol. Effectiveness of and patient preference for inhaled maintenance therapies, such as an inhaled corticosteroid in combination with a long-acting b2-agonist (ICS/LABA), can vary depending on medication components and inhaler device attributes [3,4,5]. Nonmedical medication switches are challenging for patients with asthma and COPD, as specific drug properties and inhaler devices differ among similar agents [12, 13]. Device type switching and multiple device use can lead to errors in inhalation technique, reduced disease control and quality of life, increased use of health care resources, and greater chance of unsuccessful treatment [14, 15]

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Results

Discussion

Conclusion