Higher insurance copays linked to reduced use of asthma medications in children

Increasing out-of-pocket prescription costs may be responsible for reductions in asthma medication use among children and more frequent asthma-related hospitalizations.

To determine how prescription copays for asthma among privately insured families are associated with medication use by children in those families, researchers analyzed insurance claims for 8,834 children who initiated asthma control therapy between 1997 and 2007. Of the children in the study, 2,921 were younger than 5 years, and 5,913 were aged 5 to 18 years.

Average out-of-pocket cost of asthma medications per year was $154 for those aged 5 to 18 years and $151 for those younger than 5 years. For children aged 5 to 18 years, filled asthma prescriptions covered an average of 40.9% of treatment days; for children younger than 5 years, prescriptions covered 46.2% of days.

Annual average rates of asthma-related emergency department visits and hospitalization were greater among children younger than 5 years (7.9% and 4.7%, respectively) compared with children aged 5 to 18 years (3.7% and 2.1%, respectively).

Researchers found that an increase in out-of-pocket medication costs from the 25th to the 75th percentile was associated with a reduction in adjusted medication use among children aged 5 to 18 years (41.7% vs 40.3% of days) but with no change among younger children.

Adjusted rates of asthma-related hospitalization were higher for children aged 5 to 18 years in the highest quartile of out-of-pocket asthma medication costs compared with the lowest quartile (2.4 vs 1.7 hospitalizations per 100 children), but no statistically significant difference across quartiles was found for children younger than 5 years.

The researchers conclude that greater prescription medication cost sharing among children with asthma may lead to small reductions in use of important medications with unintended consequences of more frequent asthma-related hospitalizations. They suggest that physicians look to routine access to primary care and pulmonary specialists, written care plans for families, and regularly scheduled follow-up care appointments as strategies to improve medication adherence.

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