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

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.