If we prescribe it, will it come? Access to asthma equipment for Medicaid-insured children and adults in the Bronx, NY.
BACKGROUND
Asthma is a major cause of morbidity in the United States. Self-management of asthma requires access to appropriate equipment. Clinical experience in an inner-city practice suggests that families encounter difficulties in filling prescriptions for spacers/holding chambers, peak flow (PF) meters, and nebulizer machines.


OBJECTIVE
To determine whether Bronx, NY, pharmacies (1) carry spacers/holding chambers, PF meters, and nebulizer machines; (2) accept Medicaid insurance for them; and (3) perceive barriers to reimbursement by Medicaid for this equipment.


METHODS
Structured telephone survey of 100 Bronx pharmacies randomly selected from the 1999 telephone directory.


METHODS
Ninety-eight pharmacists and 2 pharmacy technicians in 100 different pharmacies.


METHODS
Pharmacists' reports of equipment availability, Medicaid acceptance, and reasons for not carrying equipment or accepting Medicaid.


RESULTS
Overall equipment availability was as follows: spacers (68%), spacers with masks (57%), adult PF meters (40%), child-range PF meters (24%), and nebulizer machines (56%). For Medicaid recipients, equipment was less available: spacers (45%), spacers with masks (35%), adult PF meters (27%), child-range PF meters (17%), and nebulizer machines (33%). Surveyed pharmacists reported misconceptions about requirements for Medicaid reimbursement, which included the following: that Durable Medical Equipment permits are required (64% spacers and 33% PF meters), that special forms are needed (17% PF meters), or that this equipment is not covered by Medicaid (14% spacers and 8% PF meters). Of the 100 surveyed pharmacists, 32 reported difficulties with Medicaid reimbursement and 41 had never tried to receive reimbursement.


CONCLUSIONS
These results suggest that (1) access to spacers/holding chambers, PF meters, and nebulizers for Medicaid-insured families is severely limited in Bronx pharmacies; (2) misunderstandings regarding Medicaid reimbursement policies are common; and (3) interventions to increase the proportion of pharmacies that dispense equipment are needed.
Warman
Karen L
KL
Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, 1621 Eastchester Rd, Bronx, NY 10461. KWarman@Montefiore.org
Jacobs
Amanda M
AM
Silver
Ellen J
EJ
D000280:Administration, Inhalation; D000328:Adult; D001249:Asthma / Q000188:drug therapy / Q000191:economics*; D002648:Child; D011307:Drug Prescriptions; D004864:Equipment and Supplies / Q000191:economics / Q000600:supply & distribution*; D005260:Female; D006801:Humans; D007356:Insurance, Pharmaceutical Services; D008297:Male; D008329:Managed Care Programs / Q000592:standards; D008484:Medicaid / Q000592:standards*; D009330:Nebulizers and Vaporizers / Q000600:supply & distribution; D009519:New York City; D010594:Pharmacies / Q000592:standards*; D019984:Quality Indicators, Health Care; D011795:Surveys and Questionnaires; D014481:United States