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Health Serv Res. 2016 Nov 20. doi: 10.1111/1475-6773.12615. [Epub ahead of print]

Impact of Copayment Changes on Children's Albuterol Inhaler Use and Costs after the Clean Air Act Chlorofluorocarbon Ban.

Author information

  • 1Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.
  • 2Division of General Pediatrics, Boston Children's Hospital, Boston, MA.
  • 3Mongan Institute, Massachusetts General Hospital, Boston, MA.
  • 4Sanofi Genzyme, Cambridge, MA.
  • 5Roivant Sciences, Hamilton, Bermuda.
  • 6Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta, GA.
  • 7HealthPartners Institute, Minneapolis, MN.
  • 8Department of Health Care Policy, Harvard Medical School, Cambridge, MA.
  • 9Kaiser Permanente Center for Health Research Northwest, Portland, OR.
  • 10Division of Research, Kaiser Permanente Northern California, Oakland, CA.
  • 11Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.

Abstract

OBJECTIVE:

To examine changes in children's albuterol use and out-of-pocket (OOP) costs in response to increased copayments after the Food and Drug Administration banned inhalers with chlorofluorocarbon (CFC) propellants.

SETTING:

Four health maintenance organizations (HMOs), two that increased copayments for albuterol inhalers that went from generic CFC-containing to branded CFC-free versions, and two that retained generic copayments for CFC-free inhalers (controls). We included children with asthma aged 4-17 years with commercial coverage from 2007 to 2010.

DESIGN:

Interrupted time series with comparison series.

DATA:

We obtained enrollee and plan characteristics from enrollment files, and utilization data from pharmacy and medical claims; OOP expenditures were extracted from pharmacy claims for two HMOs with cost data available.

FINDINGS:

There were no significant differences in albuterol use between the group with increased cost-sharing and controls with respect to changes after the policy change. There was a postpolicy increase of $6.11 OOP per month per child using albuterol among those with increased cost-sharing versus $0.36 in controls; the difference between groups was significant (p < .01).

CONCLUSIONS:

Increased copayments for brand-name CFC-free albuterol after the CFC ban did not lead to a decrease in children's albuterol use, but it led to a modest increase in OOP costs.

KEYWORDS:

Cost-sharing; asthma; health care costs; health insurance; prescription drugs

PMID:
27868200
DOI:
10.1111/1475-6773.12615
[PubMed - as supplied by publisher]
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