Reducing out-of-pocket costs increased the number of individuals who filled prescriptions for essential inhalers.

The cost of asthma medication is a hot-button issue that can have significant consequences for disease management and patient health outcomes. According to the findings of new research released by health economist and Vancouver Coastal Health Research Institute researcher Dr. Kate Johnson, lowering out-of-pocket expenses for asthma medications increased the percentage of patients who followed through with their doctor’s orders.

Dr. Kate Johnson is an assistant professor with a joint appointment to the Faculty of Pharmaceutical Sciences and the Division of Respiratory Medicine at the University of British Columbia. She is also a research scientist at the Centre for Lung Health and at the Legacy for Airway Health.

Johnson’s study — conducted in collaboration with patient partners from the Legacy for Airway Health Community Partner Committee — addressed the limited information on cost-related non-adherence to asthma medications in B.C. and across North America. Encapsulating the two years before and after a major government policy change in B.C. that took effect in January 2019, Johnson’s study probes the impact of increased access to Fair PharmaCare coverage for some individuals.

“There is a common misconception that asthma medication is affordable; but, the patients we surveyed told us otherwise,” notes Johnson. “This study provides important evidence surrounding asthma medication affordability that can be useful to policymakers and clinicians when deciding how best to support people with this condition.”

“People may think of asthma as a mild disease, but asthma attacks or exacerbations are all too common and can result in hospitalization or even death.” 

Asthma is a chronic respiratory disease that affects more than three million Canadians of all ages, with the majority of those affected being children. Symptoms include wheezing, shortness of breath, chest tightness and coughing. For this incurable disease, proper medication adherence is one of the best lines of defense for symptom management. 

The cost factor in promoting asthma medication adherence 

Cost is commonly a factor when making decisions about medication purchases, and this is often no different when it comes to purchasing asthma inhalers, states Johnson. 

“Eliminating patient out-of-pocket costs for medications has been shown to improve medication adherence and reduce overall health care costs from, for example, hospital admissions and clinic visits.”

In her study, Johnson surveyed the health administrative data from 2017 to 2020 of 97,317 individuals from the general B.C. population with asthma who used both a controller and reliever inhaler. Of these, 12,940 were included in the case group of individuals who did not have out-of-pocket payments for their asthma inhalers and 71,331 individuals were in the control group with varying medication costs.

Reliever inhalers contain short-acting beta-agonist medication that offers immediate symptom relief. Relievers tend to be inexpensive, costing around $10 to $20 per inhaler. Controller inhalers contain corticosteroid medication and are taken as a daily maintenance therapy to reduce underlying inflammation in the lungs caused by asthma, along with asthma symptoms and the risk of symptom exacerbation. Controller medications are much more expensive, costing around $100 per inhaler.

“Patients in our sample received an average of two to three inhalers per year, with approximately half of those inhalers being the more expensive controller medications.”

“Relievers are associated with an increased risk of symptom exacerbation and mortality when overused,” Johnson explains. “As a result, international guidelines state that reliever use should be combined with the use of a corticosteroid-containing controller inhaler in most patients.”

After policy changes in January 2019, B.C. households earning less than $13,750 per year received 100 per cent public coverage for routine asthma-related medications. Previously, individuals in this income band had to cover 30 per cent of prescription costs up to a maximum of two per cent of their annual household income. Deductible and copayment reductions varied for households earning up to $45,000 annually, and there was no reduction added to deductibles or copayments for individuals in households earning more than $45,000 annually. 

Johnson and her team found that the mean number of prescriptions filled for all asthma medications increased by 22 per cent in the case group compared to the control group by the end of the study period. Controller medication prescription fulfillment increased by 4.2 per cent in the case group as compared to the control group.

The study team also compared the use of asthma medications, adherence to controller medications and excessive reliever therapy use between children and adults included in the study. They found that prescription fulfillment was greater for children than adults when out-of-pocket payments were eliminated. 

“Our study underscores the importance of cost considerations in health care delivery and decision-making,” Johnson says. “Policymakers need to incorporate these considerations into their health policy analyses, while physicians can also play an important role in informing patients about and connecting them to services and supports, such as programs that cover medication costs for qualifying individuals.” 
 

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