In the United States, more than 24 million people have asthma, and the cost of the disease is approximately $56 billion annually, according to the CDC. Direct costs, including hospital stays, account for nearly $50.1 billion of the healthcare burden, with indirect costs, such as lost pay from illness or death, comprising the other $5.9 billion.
Spending on asthma medications in 2015 decreased 1.6% from 2014, moving asthma down to the eighth most-expensive traditional therapy drug class, according to Express Scripts’ 2015 Drug Trend Report.
Despite having multiple treatment options available, approximately 10% to 20% of asthmatics are poorly controlled, studies say. Uncontrolled asthma inevitably leads to exacerbations of symptoms, or “asthma attacks.” These asthma exacerbations result in about 1.8 million emergency department visits and 3,400 deaths in the United States each year, according to the CDC.
“Medication adherence for maintenance medications is a big problem for patients, which can lead to the use of emergency inhalers and avoidable emergency department visits,” says Cynthia Ambres, a principal at KPMG Strategy and a member of the firm’s Global Healthcare Center of Excellence.
Patients most affected
Although adults comprise the majority of patients diagnosed with asthma, the pediatric population also is affected. Asthma is the leading chronic disease diagnosed in children and is the top reason for missed school days, according to Farrah Wong, PharmD, director of pipeline and drug surveillance at OptumRx.
Due to the high prevalence of Medicaid enrollees with asthma, Medicaid is the largest payer for asthma-related hospitalizations among children and adults, according to the Agency for Healthcare Research and Quality.
According to the Express Scripts Drug Trend report, asthma drugs were among the top three costliest traditional therapy classes for the Medicaid population in 2015. Medicaid plans spent $62.73 per member per year in 2015, an increase of 2.6% from 2014. The increase in spending was due to increases in drug costs; utilization actually declined slightly between 2014 and 2015. While AstraZeneca’s Symbicort (budesonide/formoterol) had the highest per member per year drug spend in Medicaid at $10.74, GlaxoSmithKline’s Ventolin HFA (albuterol sulfate) had the highest asthma market share in Medicaid.
“Patient education on the proper use of asthma therapies is key to keeping patients with asthma, particularly Medicaid enrollees, out of the hospital,” says Krista Ward, senior director of Medicaid programs at Express Scripts. “Our pulmonary specialist pharmacists encounter many patients who stop taking their medication when their symptoms abate, or rely too heavily on their rescue inhaler, and thus have poorly controlled asthma and are on the verge of a hospitalization. We’ve found that our pharmacist interventions help get them back on track and keep them out of the hospital.”