DISRUPTION IN CARE AFTER A FORCED FORMULARY SWITCH IN INHALED RESPIRATORY MEDICATIONS

Abstract

SESSION TITLE: Improving Care in COPD SESSION TYPE: Original Investigations PRESENTED ON: 10/08/2018 01:30 PM - 02:30 PM PURPOSE: To understand the treatment patterns after a formulary block for Medicare Part D patients who previously received a combination inhaled corticosteroid (ICS)/long-acting beta2 agonist (LABA) medication. METHODS: A retrospective pharmacy claims analysis evaluated patients aged ≥12 years who had Medicare Part D coverage in 2016 and 2017 and received budesonide/formoterol (BUD/FORM) fixed dose combination (FDC) as their ICS/LABA medication in 2016. Patients were followed through 12/31/2017 to observe ICS/LABA switches, changes in controller medications (monotherapy, triple therapy, therapy combinations other than ICS/LABA), and use of acute medications (oral corticosteroids, antibiotics, and rescue inhalers). RESULTS: A total of 44,832 patients were eligible, and as of 8/31/2017, 22,074 (49%) patients attempted to fill a BUD/FORM FDC prescription at the pharmacy after the formulary block on 1/1/2017, and 22,758 (51%) patients did not attempt a BUD/FORM FDC fill. Of the 22,074 patients attempting to fill, 46% were approved for ≥1 refill of BUD/FORM FDC, and 52% had their refill rejected. Of the patients with a refill rejection, 37% switched to another ICS/LABA FDC, 27% thereafter had no controller medication, 10% received monotherapy, 10% received triple therapy, and 16% received other controller combinations. For the ICS/LABA switches, patients were equally likely to switch to twice-daily as once-daily FDC agents. Of the patients who did not switch to an alternate controller therapy, 37% filled an acute medication after the block. Among patients who did not attempt to refill BUD/FORM FDC at the pharmacy in 2017, 48% switched ICS/LABA FDC with a new prescription from their physician; however, 52% did not fill any controller medication through 8/31/2017. Overall, 33% of the 44,832 patients did not fill any controller medication post-block through 8/31/2017; an additional 12% switched to monotherapy, and 17% had no inhaled medication fills. CONCLUSIONS: This Medicare Part D formulary switch was associated with a disruption in the management of patients’ respiratory conditions, with approximately 45% of patients not receiving an ICS/LABA after the formulary block, regardless of whether they attempted to refill their BUD/FORM at the pharmacy or not. CLINICAL IMPLICATIONS: This disruption in BUD/FORM FDC therapy may have impacted patients’ symptoms and disease control and potentially lead to an increased rate of costly exacerbations and hospitalizations. DISCLOSURES: Employee relationship with Astrazeneca Please note: >$100000 Added 02/28/2018 by Jill Davis, source=Web Response, value=Salary Consultant relationship with IQVIA Please note: >$100000 Added 02/28/2018 by Katie Devane, source=Web Response, value=Consulting fee Employee relationship with AstraZeneca Please note: $20001 - $100000 Added 02/22/2018 by Kathleen Fox, source=Web Response, value=Salary Employee relationship with AstraZeneca Please note: >$100000 Added 02/26/2018 by Ileen Gilbert, source=Web Response, value=Salary My spouse/partner as a Consultant relationship with St Judes Please note: $20001 - $100000 Added 02/26/2018 by Ileen Gilbert, source=Web Response, value=Consulting fee