Inhaled Corticosteroid Therapy Refill Disruption Leads to Exacerbations

Following the Medicare Part D formulary block, about half of individuals tried to fill their budesonide/formoterol prescriptions.
Following the Medicare Part D formulary block, about half of individuals tried to fill their budesonide/formoterol prescriptions.
This article is part of MPR's coverage of CHEST 2018 meeting, taking place in San Antonio, TX. Our on-site staff will be reporting on the latest breaking research and clinical advances in infectious diseases. Check back regularly for highlights from CHEST 2018 meeting.

SAN ANTONIO — Disrupting regular combination inhaled corticosteroid (ICS) therapy refills increased hospitalizations and exacerbations, according to research presented at the CHEST Annual Meeting, held October 6 to October 10, 2018, in San Antonio, Texas.

This retrospective pharmacy analysis included 44,832 individuals aged ≥12 years covered by Medicare Part D from 2016 to 2017. Following the formulary block on January 1, 2017, 49% of individuals tried to fill their budesonide/formoterol prescriptions, of which 52% were rejected and 46% were granted ≥1 refill. Of those patients denied a refill, 37% switched to another ICS/long-acting beta-agonist (LABA) combination, 27% discontinued their regimen altogether, 16% were administered alternate controller combinations, 10% were given triple therapy, and 10% were given monotherapy. Of the entire study group, 17% were not given any fills of inhaled medications, and 12% switched to monotherapy.

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Participants used ICS therapy in the form of budesonide/formoterol fixed-dose combination as well as a LABA medication starting in 2016. Participants were followed from early 2016 until the end of 2017, with primary outcomes including switches between ICS and LABA medications, acute medication use (antibiotics, rescue inhalers, oral corticosteroids), and alterations in controller medications.

The researchers concluded that, "[t]his Medicare Part D formulary switch was associated with a disruption in the management of patients' respiratory conditions, with approximately 45% of the patients not receiving an ICS/LABA after the formulary block, regardless of whether they attempted to refill their [budesonide/formoterol] at the pharmacy or not."

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Reference

Devane K, Gilbert, Davis J, Fox K. Disruption in care after a forced formulary switch in inhaled respiratory medications. Presented at: CHEST Annual Meeting 2018; October 6-10, 2018; San Antonio, TX.