The American Lung Association (ALA) is funding a new study to raise Medicaid’s awareness of the benefits of single maintenance and reliever therapy (SMART). Medicaid is the focus of the study because asthma affects more patients covered by Medicaid programs compared to those covered by private insurance. Without coverage, clinicians are hesitant to prescribe the proven therapy to their patients.
James Krings, MD, is leading the study, “Cost Analysis of SMART Therapy to Improve Asthma Outcomes,” which is funded by the association’s Public Health and Public Policy Research Award. Dr. Krings is an assistant professor of medicine at the Washington University School of Medicine in St. Louis, Missouri.
“Research from the American Lung Association has shown that many state Medicaid programs don’t optimally cover SMART despite being guideline-recommended,” Dr. Krings said. “This type of cost analysis has never been done before in the U.S.”
SMART therapy allows patients to use one inhaler that includes both an inhaled corticosteroid (ICS) and a specific long-acting bronchodilator (LABD), called formoterol. This is how one inhaler can provide everyday maintenance control and as needed relief treatments.
In previous research, Dr. Krings’s team found that the main reason clinicians don’t prescribe SMART therapy is due to a lack of insurance coverage and high, out-of-pocket costs for patients. Evidence-based, guideline-recommended SMART therapy is known to improve patient outcomes for moderate-to-severe asthma , he said. The National Heart, Lung and Blood Institute (NHLB) published the guidelines in 2020. According to Dr. Krings, only a small number of the 25 million people with asthma in the U.S. are prescribed and use SMART.
Dr. Krings’s research will include partnering with health economics investigators to determine how much it costs Medicaid to cover SMART inhalers, compared to covering a maintenance inhaler plus a separate quick-relief inhaler. Although SMART inhalers may cost Medicaid slightly more up front, their use can avoid costly emergency room visits, hospital stays and doctor appointments, which could save money in the long run.
The second part of the study will involve sharing the results with state Medicaid pharmacy directors, who decide which medications are covered.
“The medications that Medicaid decides to put on its formulary are what people will generally get,” Dr. Krings said. “We want to show Medicaid pharmacy directors that covering SMART will save them money, in addition to improving asthma patients’ outcomes,” Dr. Krings said.
Dr. Krings said he believes the impact of the study will expand Medicaid coverage of SMART therapy, ultimately allowing clinicians to prescribe it to their patients.
“The potential impact of this grant could be big,” Dr. Krings said. “It could improve access to evidence-based and guideline-recommended asthma care for those covered by state Medicaid programs. We believe that if more people are prescribed SMART, they will have better asthma outcomes.”
