Relying Too Much on Asthma Rescue Meds

Aug 19, 2013
Medicaid plans can reduce costs and improve outcomes by ensuring greater adherence to controller – not just rescue – medications among asthma patients.
  • Medicaid
  • Asthma
  • Respiratory Conditions
  • Children
  • Teenagers

Asthma disproportionately affects populations with low annual household incomes and tends to be more prevalent in urban environments. In 2012, Medicaid spent nearly $60 per member per year on asthma medications – the highest of any traditional trend category – despite the patent expiration of the blockbuster drug Singulair® (montelukast). 

Recent data published in the Express Scripts Drug Trend Report shows that certain subsets of the Medicaid population are nonadherent with their controller medications – medications that work to prevent worsening of asthma symptoms and to protect airways from causes of inflammation –and rely too much on rescue medication to relieve acute symptoms, such as wheezing or coughing.

Such behavior runs counter to asthma treatment guidelines, which recommend prevention prior to acute problems, and it often leads to suboptimal treatment and outcomes, as well as increased costs from emergency room visits and hospitalizations.

The Data: Use of Rescue Medications, Exclusively

Express Scripts researchers, comparing use of asthma therapies over time by gender, location and age, discovered that rescue medication use is more common among Medicaid members, and utilization trends for rescue medications increases at a faster rate than for controller medications.

In fact, more than half of members (55.7%) use only their rescue medication. There may certainly be an opportunity for education with these members.

While 90% of members filled at least one prescription for a rescue medication, only 42.4% filled a prescription for any type of controller medication. Also, a greater percentage of females and urban patients filled prescriptions for rescue medications as opposed to controller medications.

Medicaid utilization rescue medications by gender urbanicity

Older children and teens (ages 5-19) have greater use of controller medication, but that use declines sharply among young adults (ages 20-25). Use of controller medications increases among older members, but this is due in part to the increased prevalence of chronic obstructive pulmonary disease (COPD) in those over 40.

medicaid utilization of controller and rescue medications

Correcting the Trends

Knowing which parts of the Medicaid population are at greatest risk for nonadherence to controller medications, we can better identify individuals who require additional counseling and support with their asthma therapy.

The Express Scripts ScreenRx® program can help predict which members of the Medicaid population – as our data show, urban patients, females and young adults – are more likely to be nonadherent with their controller therapy.

We then can tailor interventions to help improve outcomes and reduce costs. Express Scripts pulmonary specialist pharmacists have deep knowledge and experience with the nuances of asthma therapy and, in their practice of treating asthma patients, have a greater understanding of the obstacles to optimal asthma treatment.

As they have seen with the millions of asthma patients they treat each day, health literacy plays a large role in asthma medication adherence. Misunderstanding the roles of controller therapy and rescue therapy is common among asthma patients, as is discontinuing therapy when symptoms subside.

I have included an audio clip of one of the conversations our pulmonary specialist pharmacists had with the mother of an asthma patient. It demonstrates how patients don't always understand exactly how to be adherent to their controller medications, and it highlights the critical role specialist pharmacists play in keeping these patients on the road to better asthma control.

Click here.

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