PDLs Associated With Medication Affordability, Adherence in Patients With Asthma

Preventative drug lists (PDLs) for asthma medications, such as combination inhaler corticosteroid long-acting β2-agonists (ICS-LABA), were associated with increased adherence among individuals with severe asthma, suggesting a potential strategy to improve access and affordability for patients enrolled in high-deductible health plans, including health savings accounts (HDHP-HSAs).

HSA savings account money | zimmytws - stock.adobe.com

“Targeting PDLs or other value-based insurance policies to patients most likely to experience cost-related nonadherence to asthma medications or those with clinical conditions that are more sensitive to cost-related nonadherence may increase the positive associations of these policies with clinical outcomes,” the researchers of the study wrote.

This case-control study is published in JAMA Network Open.

The study used enrollment and medical and pharmacy claims data from 2004 to 2017 from a large commercial and Medicare Advantage (MA) health plan in the United States. Individuals included those ages 4 to 64 years who were enrolled in an HDPD-HSA for at least 24 continuous months and had at least 1 claim within the first 6 months for an outpatient visit, emergency department (ED) visit, or hospitalization with an asthma diagnosis.

The researchers evaluated whether the patient’s employer offered a PDL that included asthma medications based on deductible and copayment amounts, using the National Drug Data File Plus to identify all asthma medications included on the insurance carrier’s PDL. Furthermore, the researchers identified periods in which employers offered a PDL with asthma medications.

Patients selected for the PDL group had a baseline period of 12 months in an HDHP-HAS without a PDL whose employers then added a PDL to include asthma controller and rescue medications. A control group of patients with 2 years of continuous enrollment through employers in a HDHP-HAS plan that did not have a PDL 12 months before or after an employer anniversary month were also included in the study. These analyses were conducted between October 2020 to June 2023.

A total of 12,174 individuals were included, with a mean (SD) age of 46.9 (16.9) years, and 6,848 (56.25%) were female.

PDLs were associated with increased annual rates of 30-day refills per enrollee, with a relative change of 12.9% (0.10 [95% CI, 0.03-0.17] fills per member) for ICS-LABA medications and 25.4% (0.06 [95% CI, 0.01-0.10] fills per member) for any controller. The proportion of days covered for ICS-LABA showed an absolute change of 6% (95% CI, 0.7% to 11.3%) or relative change of 15.6%.

Furthermore, gaining a PDL was associated with decreased out-of-pocket spending on asthma care (-$34; 95% CI, -$47 to -$21) per enrollee, which represented a 28.4% difference. However, the researchers found no significant change in asthma exacerbations for out-of-pocket spending, nor did they observe any differences in results by income.

The researchers acknowledged some limitations to the study, including its observational nature and being unable to evaluate account balances in patients’ HAS accounts, where there may be differences across study groups.

Despite these limitations, the researchers believe the study suggests that adding a PDL to a HDHP-HAS plan may result In increased patient adherence to controller medications and significantly lower out-of-pocket spending for these asthma medications.

“There were no associations with utilization of other asthma medications or asthma exacerbations,” wrote the researchers. “Adopting VBID [value-based insurance design] and other policies that exempt important medications for asthma medications are a potential strategy to reduce the cost-burden of asthma care and modestly improve adherence.”

References

Sinaiko AD, Ross-Degnan D, Wharam JF, et al. Utilization and spending with preventive drug lists for asthma medications in high-deductible health plans. JAMA Netw Open. 2023;6(8). doi:10.1001/jamanetworkopen.2023.31259