A program reducing cost sharing for chronic obstructive pulmonary disease (COPD) maintenance inhalers increased medication adherence by 15.5 percentage points among Medicare beneficiaries, according to a recent study.
A randomized clinical trial evaluated the effects of reduced cost sharing and medication management services on medication adherence among Medicare beneficiaries with COPD. The study—results from which were published in JAMA Internal Medicine—included 19,113 participants. Enrollees were 55.2% female; 9.5% of participants were Black, 81.1% were White, and 9.4% were from other or unknown racial backgrounds. The median age of the participants was 74 years. Of the 19,113 total participants, 9,601 (50.2%) were assigned to receive an invite for the intervention, while 9,512 (49.8%) were assigned to the control group.
The intervention, which reduced out-of-pocket costs for maintenance inhalers and included educational support on proper inhaler use, showed a 3.8 percentage point increase in the proportion of days covered (PDC) for inhaler use in the invited group compared with the control group.
Participants who enrolled in the program had a 55% relative improvement in adherence. Participants in the invited group had an average out-of-pocket cost of $619.50 with a standard deviation of $863.10, while those in the control group had an average cost of $675.00 with a standard deviation of $887.30. The adjusted effect of the invitation on costs was a reduction of $49.50, and the adjusted effect of the program was a reduction of $203.00.
Adherence improvements were observed across racial groups. Among Black participants, the invitation led to a 5.5 percentage point increase in PDC, with program enrollment further increasing adherence by 19.5 percentage points. White participants showed a 3.7 percentage point increase from the invitation and a 15.1 percentage point increase from enrollment. The differences in adherence improvements between Black and White participants were not statistically significant.
The study found no statistically significant effects on moderate-to-severe exacerbations, short-acting inhaler fills, or total health care spending. However, out-of-pocket prescription costs were lower in the invited group compared with the control group.
This trial showed that reducing cost sharing and providing medication management services can improve medication adherence among Medicare beneficiaries with COPD. The differences in the program's impact on racial disparities were not statistically significant.
Full disclosures can be found in the published study.
