Inhaler costs contribute to medication nonadherence for Medicare patients with chronic pulmonary disease
Research Activities, May 2011, No. 369
Medication nonadherence in the United States is common, resulting in unnecessary health care costs that have been estimated at $100 billion annually. Although Medicare Part D has decreased cost-related medication nonadherence (CRN), little is known about disease-specific nonadherence patterns after its implementation. Earlier research has shown that chronic pulmonary diseases (CPDs), such as asthma and chronic obstructive pulmonary disease (COPD), are associated with relatively high rates of cost-related nonadherence.
In a similar fashion, a new study found that patients paying more than $20 per month for inhalers were at significantly higher risk for CRN than those who did not have out-of-pocket inhaler costs. Inhaled medications (bronchodilators and corticosteroids) are a mainstay of outpatient management for asthma and COPD. Bronchodilators provide immediate, symptomatic relief, and inhaled corticosteroids contribute to better long-term outcomes in asthma and COPD.
Nearly 14,000 Medicare recipients responded to a questionnaire administered between October and December 2006. The prevalence of CRN in Medicare recipients with CPD using inhalers was 31 percent. In multivariate models, respondents with CPD using inhalers had 1.43 times greater odds of CRN compared with respondents without CPD who were not using inhalers. The median monthly out-of-pocket expenditure for prescription drugs was $80 for those with CPD who did use inhalers compared with $63 for those without CPD who did not use inhalers. In this group of Medicare recipients, patients with CPD using inhalers spent on average $35 more for out-of-pocket monthly medications than their counterparts without CPD who did not use inhalers. This study was supported by the Agency for Healthcare Research and Quality (HS09622 and T32 HS00060).
See "Inhaler costs and medication nonadherence among seniors with chronic pulmonary disease," by Peter J. Castaldi, M.D., William H. Rogers, Ph.D., Dana Gelb Safran, Sc.D., and Ira B. Wilson, M.D., in Chest 138(3), pp. 614-620, 2010.