Asthma Hits Medicaid Hardest

Mar 21, 2013
In 2012, dispensing of Medicaid asthma medications increased 6.2%. Due to poor adherence to this medicine, however, related ER visits remain high.
  • Medicaid
  • Asthma

More than 25 million people in the U.S. have asthma, a serious pulmonary condition that disproportionately impacts children in low-income populations. Asthma attacks can be life threatening and are a leading cause of emergency room visits and hospitalizations. According to the American Lung Association, the direct medical costs of asthma are $50 billion a year.

In 2012, Medicaid spent nearly $60 per member on asthma medications – the highest of any category in traditional trend – according to the Express Scripts 2012 Drug Trend Report. This is despite the availability of generic montelukast (Singulair®), a widely used asthma controller medication. Spend was largely driven by utilization, which increased 6.2%.

What’s hard to reconcile is the fact that despite this spend and increased utilization, affordable and effective asthma therapy is not reducing ER visits and hospitalizations. Why?

The biggest barrier is nonadherence to asthma controller medications, such as long-acting beta agonists and leukotriene modifiers, which can reduce the number and severity of asthma attacks with proper use over time. Some of the major barriers to nonadherence include:

Age: Children have a limited ability to understand their medications and may have a variety of caregivers throughout the day beyond their primary guardians, leading to inconsistent therapy administration.

Health literacy: Adult asthma patients and caregivers for younger patients may not fully understand the relationship between medication and health outcomes. Controller medications must be used every day to prevent attacks, not just when symptoms are present. Others stop taking controller therapy when they begin to feel better, not understanding that ceasing therapy will bring their symptoms back.

Complexity of therapy: Some asthma patients have difficulty adhering to therapy that requires multiple treatments per day; others have issues with access to care, length of therapy, adverse experiences with previous medications and the presence of another condition.

Understanding these barriers to effective asthma treatment is key to improving patient outcomes and reducing costs, which is especially important with upcoming changes to Medicaid as a result of the Affordable Care Act. Consistent patient support and programs that improve health literacy can help address these issues.

Additional Drivers of Medicaid Spend

Overall Medicaid drug spending increased 7.8%, driven almost equally by increases in unit cost and utilization.

Table showing Medicare Drug Trends

Beneficiaries ages 35 to 64 were the biggest drivers of spend – 18.9% – reflecting growth in the use of traditional and specialty medications, the latter of which accounted for a larger proportion of total spend in this age group than in other age groups. However, cost increases for specialty in Medicaid overall were less than in our commercial book of business, likely attributed to types of specialty medications used by this population.

Attention deficit disorder medications were the third leading driver of spend, primarily due to a 12.3% increase in use. While there has been an increase in use among adults, some of the increase in utilization among Medicaid beneficiaries was seen in the 19-and-under age group. Evidence suggests that a portion of the increased prescribing of attention deficit disorder medications for low-income children is due to efforts to improve school performance and grades.

Lastly, use of medications used to manage chemical dependence, such as Campral® (acamprosate), Suboxone® (buprenorphine, naloxone) and disulfiram, has increased 15.4% in the Medicaid population, leading to the highest total trend among traditional medications. More addictions are being treated with medication therapy, leading to a rise in the use of these medications. Research suggests that the economic recession and slow recovery are linked to an increase in substance abuse that might explain the rise in the use of these medications among Medicaid populations.

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