title: Impact of Copayment Changes on Children's Albuterol Inhaler Use and Costs after the Clean Air Act Chlorofluorocarbon Ban.
abstract: To examine changes in children's albuterol use and out-of-pocket (OOP) costs in response to increased copayments after the Food and Drug Administration banned inhalers with chlorofluorocarbon (CFC) propellants.
  
  
  
  Four health maintenance organizations (HMOs), two that increased copayments for albuterol inhalers that went from generic CFC-containing to branded CFC-free versions, and two that retained generic copayments for CFC-free inhalers (controls). We included children with asthma aged 4-17 years with commercial coverage from 2007 to 2010.
  
  
  
  Interrupted time series with comparison series.
  
  
  
  We obtained enrollee and plan characteristics from enrollment files, and utilization data from pharmacy and medical claims; OOP expenditures were extracted from pharmacy claims for two HMOs with cost data available.
  
  
  
  There were no significant differences in albuterol use between the group with increased cost-sharing and controls with respect to changes after the policy change. There was a postpolicy increase of $6.11 OOP per month per child using albuterol among those with increased cost-sharing versus $0.36 in controls; the difference between groups was significant (p < .01).
  
  
  
  Increased copayments for brand-name CFC-free albuterol after the CFC ban did not lead to a decrease in children's albuterol use, but it led to a modest increase in OOP costs.
authors.affiliation: Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.|Division of General Pediatrics, Boston Children's Hospital, Boston, MA.
authors.forename: Alison A
authors.initials: AA
authors.lastname: Galbraith
authors.affiliation: Mongan Institute, Massachusetts General Hospital, Boston, MA.
authors.forename: Vicki
authors.initials: V
authors.lastname: Fung
authors.affiliation: Sanofi Genzyme, Cambridge, MA.
authors.forename: Lingling
authors.initials: L
authors.lastname: Li
authors.affiliation: Roivant Sciences, Hamilton, Bermuda.|Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta, GA.
authors.forename: Melissa G
authors.initials: MG
authors.lastname: Butler
authors.affiliation: HealthPartners Institute, Minneapolis, MN.
authors.forename: James D
authors.initials: JD
authors.lastname: Nordin
authors.affiliation: Mongan Institute, Massachusetts General Hospital, Boston, MA.|Department of Health Care Policy, Harvard Medical School, Cambridge, MA.
authors.forename: John
authors.initials: J
authors.lastname: Hsu
authors.affiliation: Kaiser Permanente Center for Health Research Northwest, Portland, OR.
authors.forename: David
authors.initials: D
authors.lastname: Smith
authors.affiliation: Kaiser Permanente Center for Health Research Northwest, Portland, OR.
authors.forename: William M
authors.initials: WM
authors.lastname: Vollmer
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA.
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Lieu
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Soumerai
authors.affiliation: Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.|Division of General Pediatrics, Boston Children's Hospital, Boston, MA.
authors.forename: Ann Chen
authors.initials: AC
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D000420:Albuterol / Q000191:economics*; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D017402:Chlorofluorocarbons; D017047:Cost Sharing / Q000706:statistics & numerical data*; D005260:Female; D006279:Health Maintenance Organizations / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review; D065186:Interrupted Time Series Analysis; D008297:Male; D009330:Nebulizers and Vaporizers / Q000191:economics*; D012987:Soil
chemical_list: D017402:Chlorofluorocarbons; D012987:Soil; D000420:Albuterol
keywords: Cost-sharing; asthma; health care costs; health insurance; prescription drugs