Department of Medicine, University of Chicago, 5841 S Maryland Avenue, MC 2007, Chicago, IL, 60637, USA.
Department of Pediatrics, University of Chicago, Chicago, IL, USA.
BMC Health Serv Res. 2022 Apr 26;22(1):562. doi: 10.1186/s12913-022-07955-x.
Oral albuterol has worse efficacy and side effects compared with inhaled albuterol, and thus its use has been discouraged for decades. Drug inclusion or exclusion on formularies have been associated with reductions in low-value care. This study examines dispensing of oral albuterol and inclusion of oral albuterol on state Medicaid drug formularies--Preferred Drug Lists (PDLs). It also evaluates the association between removal of oral albuterol from the PDL and dispensing levels.
This quasi-experimental study determined oral albuterol inclusion on PDLs and dispensing between 2011 and 2018, using Medicaid program websites and the State Drug Utilization Database. Using a difference-in-differences model, we examine the association between removal of oral albuterol from Arkansas' Medicaid PDL in 2014 and dispensing of this drug through Medicaid, with Iowa as a control state. The outcome measure was the percent of all albuterol prescriptions that were for oral albuterol.
A total of 28 state Medicaid PDLs included at least one formulation of oral albuterol in 2018. In 2018, 179,446 oral albuterol prescriptions were dispensed to Medicaid beneficiaries nationally. Medicaid programs paid approximately $3.0 million for oral albuterol prescriptions in 2018. Removal of oral albuterol syrup from the Arkansas PDL in March 2014 was associated with a more rapid decline in dispensing compared with Iowa which maintained this medication on their PDL.
Findings suggest that removal of low-value medications, such as oral albuterol, from PDLs may be one avenue by which state Medicaid programs can reduce wasteful spending while improving guideline-based care.
与吸入用沙丁胺醇相比，口服沙丁胺醇的疗效和副作用更差，因此几十年来一直不鼓励使用。药物是否纳入或排除在处方集与低价值医疗保健的减少有关。本研究检查了口服沙丁胺醇的配药情况和州医疗补助计划（Medicaid）药物处方集（首选药物清单（PDL））中口服沙丁胺醇的纳入情况。它还评估了从 PDL 中删除口服沙丁胺醇与配药水平之间的关系。
本准实验研究使用医疗补助计划网站和州药物利用数据库，确定了 2011 年至 2018 年期间 PDL 上的口服沙丁胺醇纳入情况和配药情况。使用差异中的差异模型，我们检查了 2014 年阿肯色州医疗补助 PDL 中删除口服沙丁胺醇与通过医疗补助开这种药物之间的关联，爱荷华州作为对照州。结果衡量标准是所有沙丁胺醇处方中口服沙丁胺醇的百分比。
2018 年，共有 28 个州医疗补助 PDL 纳入了至少一种口服沙丁胺醇制剂。2018 年，全国向医疗补助受益人开出了 179446 张口服沙丁胺醇处方。2018 年，医疗补助计划为口服沙丁胺醇处方支付了约 300 万美元。2014 年 3 月，阿肯色州 PDL 中删除口服沙丁胺醇糖浆与爱荷华州相比，与爱荷华州相比，配药的下降速度更快，爱荷华州仍然保留了这种药物。
研究结果表明，从 PDL 中删除低价值药物，如口服沙丁胺醇，可能是州医疗补助计划减少浪费性支出同时改善基于指南的护理的一种途径。
