Study: Preventative Drug Lists Improve Affordability, Adherence to Asthma Medication


Preventative drug lists were associated with a modest increase in adherence to combination inhaled corticosteroid long-acting β2-agonists.

A preventative drug list has been associated with improved affordability of asthma medication and an increase in controller medication use; however, investigators found that there was no difference in the clinical outcomes of asthma, according to results of a study published in JAMA Network Open.

Woman holding asthma inhaler on color background, top view. | Image Credit: New Africa -

New Africa -

Although there are data to support the use and efficacy of controller medications, adherence remains difficult for patients. High out-of-pocket costs continue to be a barrier for asthma medication and adherence, according to the study investigators. Preventative drugs lists are part of “value-based insurance design and aim to preserve use of important medications through elimination of cost-related barriers to care,” the authors stated.

The study authors aimed to determine whether there was an association with preventative drug lists and utilization, adverse outcomes, and cost for individuals with asthma who are enrolled on a high-deductible health plan with a health savings account. The study used a case-control design, where individuals with asthma were matched before and after undergoing an insurance change. Investigators used data from claims from national commercial health insurance between 2004 and 2017 and included individuals from all 50 states.

Individuals in the study were aged 4 to 64 and had been enrolled on a high-deductible health plan with a health savings account for 1 year without a preventative drug list of asthma medication. Because of this, the asthma drugs were subjected to a deductible. The investigators switched these individuals to a high-deductible health plan with a health savings account that had a preventative drug list and were matched with individuals who were enrolled with a high-deductible health plan without a preventative drug list for 2 years. The analyses were conducted from October 2020 to June 2023, according to the study authors.

Investigators included 12,174 individuals with a mean age of 36.9 and 56.25% were female. They found that preventative drug lists were associated with an increase rate of 30-day fills of a controller and combination inhaled corticosteroid long-acting β2-agonist medications for individuals at 12.9% and 25.4%, respectively, when compared to those who did not have a preventative drug list. Furthermore, they found that the lists were also associated with an increased number of days that covered the inhaled corticosteroid long-acting β2-agonist medication at 15.6%.

The study authors reported that a preventative drug list was also associated with decreased out-of-pocket spending at 28.4% for asthma care. However, the results did not show a significant change in asthma outcomes. The results were also similar when stratified for patient income.

Investigators concluded that the preventative drug lists were associated with a modest increase in adherence to the controller medications, particularly for combination inhaled corticosteroid long-acting β2-agonists. They also said that access to the lists were also associated with reductions of out-of-pocket spending. According to the study investigators, adopting the value-based insurance design could help increase access to important medication for patients and improve adherence.

Additionally, the study had limitations, which included the observational nature of the study. This affected how random the study was. Furthermore, the study authors stated that the findings might not be generalizable to individuals who have public insurance, more severe asthma, regular baseline controller use, or comorbid pulmonary conditions.


Sinaiko AD, Ross-Degnan D, Wharam JF, LeCates RF, et al. Utilization and Spending With Preventive Drug Lists for Asthma Medications in High-Deductible Health Plans. JAMA Netw Open. 2023;6(8):e2331259. doi:10.1001/jamanetworkopen.2023.31259

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