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Home-Based Prescribed Pulmonary Exercise in Patients with Stable Chronic Obstructive Pulmonary Disease

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Reduced Cost Sharing and Medication Management Services for COPD: A Randomized Clinical Trial.

Sumit D Agarwal^1,2, Elizabeth Metzler³, Michael Chernew²

¹Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.

JAMA Internal Medicine

|July 29, 2024

Summary

A program reducing costs for maintenance inhalers and offering medication management significantly improved adherence for chronic obstructive pulmonary disease (COPD) patients. This intervention lowered out-of-pocket spending but did not significantly affect exacerbations or total costs.

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Area of Science:

Health Services Research
Pulmonary Medicine
Health Economics

Background:

High out-of-pocket costs and improper inhaler use negatively impact chronic obstructive pulmonary disease (COPD) patient outcomes.
Limited evidence exists on interventions addressing these barriers to improve adherence and reduce exacerbations or healthcare spending.

Purpose of the Study:

To evaluate a national program aimed at reducing cost sharing for COPD maintenance inhalers.
To assess the impact of medication management services, including inhaler technique education, on patient adherence and outcomes.

Main Methods:

A randomized clinical trial involving Medicare Advantage enrollees with COPD.
Participants were randomized to receive an invitation for a program offering reduced inhaler costs ($0 or $10) and medication management services.
Effects were estimated using intention-to-treat and treatment-on-the-treated analyses, examining outcomes overall and by race.

Main Results:

The program invitation led to a 3.8 percentage point increase in maintenance inhaler adherence (Proportion of Days Covered).
Program enrollment resulted in a 15.5 percentage point increase in adherence (55% relative increase) and reduced mean out-of-pocket prescription spending by $203.
No statistically significant differences were observed in exacerbations, short-acting inhaler fills, or total healthcare spending. The program showed a substantial, though not statistically significant, difference in adherence improvement between Black and White individuals.

Conclusions:

A program reducing cost sharing and providing medication management services effectively increased maintenance inhaler adherence among COPD patients in Medicare Advantage.
The intervention successfully lowered out-of-pocket spending for these patients.
While the program demonstrated potential for reducing racial disparities in adherence, further research is needed to confirm these findings and their clinical significance.