COPD inhaler adherence rises with lower cost sharing, medication management service invite

Key takeaways:

• Invited patients had 32% of days covered for maintenance inhalers, whereas control patients had a smaller proportion of days covered.
• Compared with control patients, invited patients spent less out-of-pocket.

Patients with COPD had better inhaler adherence when invited to enroll in a program that lowers cost sharing for maintenance inhalers and offers medication management services, according to results published in JAMA Internal Medicine.

“These findings contribute to the limited evidence of interventions that can improve inhaler adherence in COPD, a disease with high morbidity whose costs are disproportionately incurred by Medicare, and the even more limited evidence addressing cost-related nonadherence, a growing concern given the high prices of inhalers,” Sumit D. Agarwal, MD, MPH, PhD, physician and health economist at Brigham and Women’s Hospital, and colleagues wrote.

In a randomized clinical trial, Agarwal and colleagues analyzed 19,113 patients (median age, 74 years; 55.2% women; 81.1% white; 9.5% Black) with COPD enrolled in Medicare Advantage to determine if a program that lowers cost sharing for maintenance inhalers to as low as $0 and offers medication management services impacts inhaler adherence.

Researchers evaluated five different variables when capturing inhaler adherence: proportion of days covered, moderate to severe exacerbations, short-acting inhaler fills, total spending and out-of-pocket spending.

The total cohort was divided into patients invited to enroll in the program (n = 9,601) and patients who acted as controls (n = 9,512).

A greater proportion of invited vs. control patients enrolled in the program (29.4% vs. 5.1%).

Invited patients had 32% of days covered for maintenance inhalers, whereas control patients had a smaller proportion of days covered for maintenance inhalers at 28.4% (adjusted invitation effect, 3.8 percentage points). Notably, researchers also found that the adjusted program effect (15.5 percentage points) signaled a relative rise in adherence by 55%.

Compared with control patients, invited patients also spent less out-of-pocket (mean, $619.50 vs. $675; adjusted invitation effect, –$49.5; adjusted program effect, –$203).

In contrast, exacerbations, short-acting inhaler fills and total spending each did not significantly differ between the invited group and the control group.

When divided by race, Black vs. white patients had a higher adjusted invitation effect on maintenance inhaler proportion of days covered (5.5 vs. 3.7 percentage points) and a higher adjusted program effect (19.5 vs. 15.1 percentage points), but the difference calculated within each effect did not reach statistical significance.

“To better align insurance coverage with clinical benefit, insurers might consider selectively lowering cost sharing and providing medication management services for clinically effective, high-value services,” Agarwal and colleagues wrote.