The Effects of Payor-Initiated Inhaled Corticosteroids Switc
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A Study was conducted to evaluate the impact of a payor-initiated formulary change in inhaled corticosteroid coverage on lung function in patients with asthma and on provider prescribing practices. This formulary change, eliminated coverage of beclomethasone dipropionate (BDP), a metered dose inhaler (MDI), in favor of mometasone furoate, available as MDI and dry powder inhaler (DPI).

A retrospective chart review was conducted on children with asthma ages 6 to 18 covered by the relevant payor from a university-based pediatric practice who were seen before the formulary change (February to July 2016) and after (February to July 2017). Spirometry data from each visit was compared using the paired Student t-test.

Results:
--58 patients were identified who were initially on BDP and had spirometry available at both visits.

--Those who switched from an MDI to a DPI (n=24) saw a decline in median predicted FEV 1 from 98.5% to 91%.

--A decline was also seen in FEF 25-75, from 89.5% predicted to 76% predicted.

--No significant changes were observed in children remaining on an MDI. 7 patients discontinued ICS therapy.

In conclusion, this research indicates that insurance formulary adjustments could contribute to the use of a different inhaler drug, which could have a negative effect on pediatric lung function, which could be a proxy for overall asthma control. This may be due to a lack of timely educational intervention as well as certain children's inability to use DPIs.

Source: https://www.jpeds.com/article/S0022-3476(21)00220-1/fulltext?rss=yes
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