Access and Insurance Coverage for Low-Emission Inhalers in Commercial Health Plans
Overview
This study evaluates the formulary coverage and patient cost-sharing for low-emission inhalers in US commercial health plans, highlighting disparities in coverage between propellant-containing metered-dose inhalers (MDIs) and propellant-free alternatives like dry powder inhalers (DPIs) and soft mist inhalers (SMIs).
Background
Asthma and chronic obstructive pulmonary disease (COPD) are major respiratory conditions treated with inhalers, which can have substantial environmental impacts due to their propellants. The accessibility of inhalers is often influenced by insurance formulary decisions, which can limit patient access to lower-emission alternatives. Understanding these coverage patterns is crucial for promoting environmentally friendly inhaler options.
Data Highlights
Therapeutic Class
MDI Coverage (%)
DPI/SMI Coverage (%)
SABAs
99.6
33.2
ICS
99.4
89.5
ICS-LABAs
99.1
82.6
Key Findings
Nearly all commercial plans cover propellant-containing MDIs across therapeutic classes (SABAs: 99.6%, ICS: 99.4%, ICS-LABAs: 99.1%).
Only 33.2% of plans cover a propellant-free DPI or SMI for SABAs.
Lower-barrier access for propellant-free devices is significantly less common compared to MDIs, with only 7.8% for SABAs.
Among ICS and ICS-LABAs, coverage of both device types is more prevalent, with 89.3% and 82.0% respectively.
Approximately 97% of inhaler-associated greenhouse gas emissions in the US derive from SABAs, ICS, and ICS-LABAs.
Coverage obstacles favoring MDIs are evident across the US insurance landscape, similar to findings in Medicare plans.
Clinical Implications
Clinicians should be aware of disparities in insurance coverage for inhalers when prescribing.
Conclusion
This study reveals critical gaps in insurance coverage for low-emission inhalers, particularly for SABAs, which may hinder efforts to reduce inhaler-related greenhouse gas emissions.
