CHEST 2019 — Decreased asthma control in children following an insurance formulary change


  • Keren Landman, MD
  • Conference Reports
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • Children taking inhaled steroids for asthma had reduced lung function when a Medicaid formulary change led to a switch from metered dose inhalers (MDIs) to dry powder inhalers (DPIs).

Why this matters

  • Insurance formulary coverage changes are an important reason for medication changes in otherwise stable patients, and may lead to changes in health status.

Study design

  • Retrospective chart review of 68 children with asthma ages 6-18 years at an academic medical center's general pediatric clinic.
  • Subjects had all been clinic patients during a major regional Medicaid provider's formulary change and had spirometry before and after the change.
    • The change resulted in discontinued coverage of beclomethasone dipropionate delivered by an MDI in favor of mometasone furoate, available as both an MDI and a DPI.
  • Funding: None.

Key results

  • 98.5% of patients on inhaled controlled therapy took an MDI prior to the formulary change, compared with 60% after the change.
  • Among 24 patients who changed to a DPI:
    • Average FEV1 decreased from 99% to 89% postchange.
    • FEF25%-75% decreased from 89% to 77% postchange.
  • No statistically significant changes in lung function were observed among children who remained on an MDI.

Limitations

  • Retrospective review.
  • Physicians not blinded to patient's medication list.

Expert commentary

  • In a press release, Victor Test, MD, Co-Chair of the CHEST Scientific Program Committee and Professor at Texas Tech University Health Sciences Center, was quoted as saying, “This study demonstrates that formulary-dictated changes in inhaled corticosteroids decreases control of asthma and raises the following question: Are changes in formulary driven only by financial concerns appropriate in patients with asthma?” Dr. Test was not involved in the study.