CHEST 2019 — Decreased asthma control in children following an insurance formulary change

Study design

• Retrospective chart review of 68 children with asthma ages 6-18 years at an academic medical center's general pediatric clinic.
• Subjects had all been clinic patients during a major regional Medicaid provider's formulary change and had spirometry before and after the change.
  • The change resulted in discontinued coverage of beclomethasone dipropionate delivered by an MDI in favor of mometasone furoate, available as both an MDI and a DPI.
• Funding: None.

Key results

• 98.5% of patients on inhaled controlled therapy took an MDI prior to the formulary change, compared with 60% after the change.
• Among 24 patients who changed to a DPI:
  • Average FEV1 decreased from 99% to 89% postchange.
  • FEF25%-75% decreased from 89% to 77% postchange.
• No statistically significant changes in lung function were observed among children who remained on an MDI.

Limitations

• Retrospective review.
• Physicians not blinded to patient's medication list.

Expert commentary

• In a press release, Victor Test, MD, Co-Chair of the CHEST Scientific Program Committee and Professor at Texas Tech University Health Sciences Center, was quoted as saying, “This study demonstrates that formulary-dictated changes in inhaled corticosteroids decreases control of asthma and raises the following question: Are changes in formulary driven only by financial concerns appropriate in patients with asthma?” Dr. Test was not involved in the study.