Utilization and access to metered-dose inhalers and sustainable alternatives among older adults in the United States: a population-based studyResearch in context
Summary: Background: Attaining the Paris Agreement goal of limiting global temperature rise to below 1.5–2 °C requires the healthcare sector to achieve net-zero emissions by 2050. This necessitates adopting diverse strategies, including replacing carbon-intensive metered-dose inhalers (MDIs) with m...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-07-01
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| Series: | The Lancet Regional Health. Americas |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2667193X25001528 |
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| author | Ashwaghosha Parthasarathi Isao Iwata Catherine Chen Amy R. Li Novella Lye Poonam Gandhi Melanie Rua Reynold A. Panettieri, Jr. Jared Radbel Mahesh Padukudru Anand Mary Bridgeman Soko Setoguchi |
| author_facet | Ashwaghosha Parthasarathi Isao Iwata Catherine Chen Amy R. Li Novella Lye Poonam Gandhi Melanie Rua Reynold A. Panettieri, Jr. Jared Radbel Mahesh Padukudru Anand Mary Bridgeman Soko Setoguchi |
| author_sort | Ashwaghosha Parthasarathi |
| collection | DOAJ |
| description | Summary: Background: Attaining the Paris Agreement goal of limiting global temperature rise to below 1.5–2 °C requires the healthcare sector to achieve net-zero emissions by 2050. This necessitates adopting diverse strategies, including replacing carbon-intensive metered-dose inhalers (MDIs) with more environmentally sustainable dry powder inhalers (DPIs) and soft mist inhalers (SMIs). While several European countries have successfully made this transition, patterns of MDI use and barriers to adopting sustainable alternatives in the United States remain poorly understood. Thus, we assessed inhaler utilization, costs, and insurance coverage among U.S. older adults. Methods: Using 100% fee-for-service Medicare data with pharmacy benefit (2008–2022), we described utilization trends and costs by device types and drug classes, including inhaled corticosteroids [ICS] and short-/long-acting beta-agonists [S/LABA]. Using the COVERAGE Search database, we extracted formulary data from Part D plans in 10 large US states and described insurance coverage, formulary tier placement (categorizing drugs by costs), prior authorization (requiring insurer approval for coverage), and step therapy (requiring initial trial of lower-cost drugs). Findings: Of 160,845,280 inhalers dispensed to 10,494,068 older adults (mean age 74 ± 7 years; 38% male; 85% White), 51% were MDIs. Of these MDIs, 88% were SABA and ICS. Median deductible-phase out-of-pocket costs were $3–9 for SABA MDIs vs. $42–49 for DPIs/SMIs and $3–4 for ICS MDIs vs. $3–116 for DPIs/SMIs. Only 18% and 50% of 2530 Part D plans covered SABA and ICS DPIs, respectively. Among the covering plans, >70% placed DPIs for SABA or ICS in higher-cost tiers, with 32–58% requiring prior authorization or step therapy. Interpretation: MDIs, primarily as SABA or ICS, accounted for over half of inhalers dispensed to US older adults. Most insurance plans excluded sustainable alternatives for SABA/ICS. When covered, additional approval steps and/or higher patient costs were posed. Multi-level efforts are needed to ensure affordable access to sustainable alternatives, as demonstrated in European countries. Funding: Funding for this study was provided by the National Institutes of Health and the National Institute on Aging (1R01AG060232-01A1). |
| format | Article |
| id | doaj-art-08d7f75bc3e645f481daf216e341a5df |
| institution | OA Journals |
| issn | 2667-193X |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health. Americas |
| spelling | doaj-art-08d7f75bc3e645f481daf216e341a5df2025-08-20T02:05:11ZengElsevierThe Lancet Regional Health. Americas2667-193X2025-07-014710114210.1016/j.lana.2025.101142Utilization and access to metered-dose inhalers and sustainable alternatives among older adults in the United States: a population-based studyResearch in contextAshwaghosha Parthasarathi0Isao Iwata1Catherine Chen2Amy R. Li3Novella Lye4Poonam Gandhi5Melanie Rua6Reynold A. Panettieri, Jr.7Jared Radbel8Mahesh Padukudru Anand9Mary Bridgeman10Soko Setoguchi11Rutgers RWJBarnabas Center for Climate, Health and Healthcare, New Brunswick, NJ, USA; Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy, and Aging Research, New Brunswick, NJ, USAMedical Education Center, University of Occupational and Environmental Health, Kitakyushu, JapanRutgers RWJBarnabas Center for Climate, Health and Healthcare, New Brunswick, NJ, USA; Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USARutgers RWJBarnabas Center for Climate, Health and Healthcare, New Brunswick, NJ, USA; Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy, and Aging Research, New Brunswick, NJ, USARutgers RWJBarnabas Center for Climate, Health and Healthcare, New Brunswick, NJ, USA; Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy, and Aging Research, New Brunswick, NJ, USACenter for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy, and Aging Research, New Brunswick, NJ, USARutgers RWJBarnabas Center for Climate, Health and Healthcare, New Brunswick, NJ, USA; Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy, and Aging Research, New Brunswick, NJ, USADepartment of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA; Rutgers Institute for Translational Medicine and Science, Child Health Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USADepartment of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USADepartment of Respiratory Medicine, JSS Medical College, JSSAHER, Mysore, Karnataka, IndiaDepartment of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ, USA; Department of Pharmacy, Robert Wood Johnson University Hospital, New Brunswick, NJ, USARutgers RWJBarnabas Center for Climate, Health and Healthcare, New Brunswick, NJ, USA; Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA; Corresponding author. 112 Paterson Street, New Brunswick, NJ, 08901-1293, USA.Summary: Background: Attaining the Paris Agreement goal of limiting global temperature rise to below 1.5–2 °C requires the healthcare sector to achieve net-zero emissions by 2050. This necessitates adopting diverse strategies, including replacing carbon-intensive metered-dose inhalers (MDIs) with more environmentally sustainable dry powder inhalers (DPIs) and soft mist inhalers (SMIs). While several European countries have successfully made this transition, patterns of MDI use and barriers to adopting sustainable alternatives in the United States remain poorly understood. Thus, we assessed inhaler utilization, costs, and insurance coverage among U.S. older adults. Methods: Using 100% fee-for-service Medicare data with pharmacy benefit (2008–2022), we described utilization trends and costs by device types and drug classes, including inhaled corticosteroids [ICS] and short-/long-acting beta-agonists [S/LABA]. Using the COVERAGE Search database, we extracted formulary data from Part D plans in 10 large US states and described insurance coverage, formulary tier placement (categorizing drugs by costs), prior authorization (requiring insurer approval for coverage), and step therapy (requiring initial trial of lower-cost drugs). Findings: Of 160,845,280 inhalers dispensed to 10,494,068 older adults (mean age 74 ± 7 years; 38% male; 85% White), 51% were MDIs. Of these MDIs, 88% were SABA and ICS. Median deductible-phase out-of-pocket costs were $3–9 for SABA MDIs vs. $42–49 for DPIs/SMIs and $3–4 for ICS MDIs vs. $3–116 for DPIs/SMIs. Only 18% and 50% of 2530 Part D plans covered SABA and ICS DPIs, respectively. Among the covering plans, >70% placed DPIs for SABA or ICS in higher-cost tiers, with 32–58% requiring prior authorization or step therapy. Interpretation: MDIs, primarily as SABA or ICS, accounted for over half of inhalers dispensed to US older adults. Most insurance plans excluded sustainable alternatives for SABA/ICS. When covered, additional approval steps and/or higher patient costs were posed. Multi-level efforts are needed to ensure affordable access to sustainable alternatives, as demonstrated in European countries. Funding: Funding for this study was provided by the National Institutes of Health and the National Institute on Aging (1R01AG060232-01A1).http://www.sciencedirect.com/science/article/pii/S2667193X25001528Metered-dose inhalerSustainable inhaler useInhaler insurance coverageInhaler costsInhaler dispensingMedicare |
| spellingShingle | Ashwaghosha Parthasarathi Isao Iwata Catherine Chen Amy R. Li Novella Lye Poonam Gandhi Melanie Rua Reynold A. Panettieri, Jr. Jared Radbel Mahesh Padukudru Anand Mary Bridgeman Soko Setoguchi Utilization and access to metered-dose inhalers and sustainable alternatives among older adults in the United States: a population-based studyResearch in context The Lancet Regional Health. Americas Metered-dose inhaler Sustainable inhaler use Inhaler insurance coverage Inhaler costs Inhaler dispensing Medicare |
| title | Utilization and access to metered-dose inhalers and sustainable alternatives among older adults in the United States: a population-based studyResearch in context |
| title_full | Utilization and access to metered-dose inhalers and sustainable alternatives among older adults in the United States: a population-based studyResearch in context |
| title_fullStr | Utilization and access to metered-dose inhalers and sustainable alternatives among older adults in the United States: a population-based studyResearch in context |
| title_full_unstemmed | Utilization and access to metered-dose inhalers and sustainable alternatives among older adults in the United States: a population-based studyResearch in context |
| title_short | Utilization and access to metered-dose inhalers and sustainable alternatives among older adults in the United States: a population-based studyResearch in context |
| title_sort | utilization and access to metered dose inhalers and sustainable alternatives among older adults in the united states a population based studyresearch in context |
| topic | Metered-dose inhaler Sustainable inhaler use Inhaler insurance coverage Inhaler costs Inhaler dispensing Medicare |
| url | http://www.sciencedirect.com/science/article/pii/S2667193X25001528 |
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