A novel study found that asthmatic children forced to switch inhaler types to accommodate insurance formulary changes may experience a loss of lung function.
Inhaled corticosteroid (ICS) therapy, a cornerstone of daily asthma management, is delivered by several types of inhalers that require different usage techniques. Insurance formulary coverage often dictates inhaler selection and can change abruptly, requiring children to switch inhaler types with little notice, wrote the article’s author, Scott Bickel, MD, with the University of Louisville School of Medicine.
Bickel and colleagues found that, when a major Medicaid regional provider switched from beclomethasone dipropionate (BDP) delivered via a metered dose inhaler (MDI) to an ICS delivered by a dry powder inhaler on its formulary, pediatric asthma patients had a loss of lung function compared to those who did not switch. “Anecdotally, this change caused considerable confusion among both providers and families,” Bickel wrote in the abstract.
"Changes in insurance formulary coverage are a major reason why patients who are otherwise stable are switched to a different asthma medication," said Bickel in a press release from CHEST 2019. "Our findings suggest that when considering formulary changes, insurance organizations should take into account the unique needs of pediatric patients with asthma, ensuring all children have access to the inhaler device that is most appropriate for their individualized care."
Bickel and other researchers retrospectively reviewed charts of children aged 6 to 18 years with asthma served by the impacted Medicaid plan from a large, university-based general pediatric clinic who had spirometry performed both before and after the formulary change.
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Sixty-eight patients were identified on inhaled controller therapy with 98.5% being supported by MDIs prior to the formulary change and 60% afterward.