181 - Descriptive analysis of Access to Single Maintenance and Reliever Therapy (SMART) among pediatric patients with Medicaid insurance in the District of Columbia

Poster Number: 181
Publication Number: 181.35

Background: Pediatric asthma morbidity is disparately higher among under-resourced patients with Medicaid insurance. The use of single maintenance and reliever therapy (SMART) has demonstrated a reduction in the need for systemic steroids and emergency department utilization for asthma exacerbations when compared to traditional asthma maintenance regimens. Despite a strong recommendation for SMART in the 2020 updated asthma guidelines, widespread implementation has been limited due to inadequate insurance coverage.

Objective: To describe local Medicaid coverage of guideline-directed asthma therapy with a focus on SMART and to investigate demographic disparities related to formulary restrictions.

Design/Methods: We conducted a retrospective descriptive analysis of formulary coverage. Inclusion criteria were (1) age 4-17 years (2) residence in the District of Columbia (D.C.) (3) documented insurance by a DC Medicaid Managed Care Organization (MCO) (4) medical encounter between 9/1/22 and 9/1/23. We reviewed the 2023 MCO formularies for coverage of SMART-compatible inhalers. Adequate SMART coverage was defined as 3 ICS-formoterol metered dose inhalers (MDI) per month. Data was extracted from the citywide asthma registry and de-identified; analysis was performed using STATA 14.

Results: 12,122 patients were included for data analysis. One of the four MCOs reviewed (Insurer A) does not provide access to SMART and covers 58% of this population (7,013 patients). Insurers B, C and D collectively cover 42% of the patients and provide adequate access to SMART (Table 1). There were no significant differences in demographics between insurer groups (Table 2). There was also no significant difference in demographics when comparing patients with (insured by B, C and D) and without (insured by A) coverage to SMART.

Conclusion(s): A majority of pediatric patients with asthma in D.C. insured by Medicaid do not have access to SMART. This highlights the inequities in medication access among an already disadvantaged population and supports advocating for a single common formulary for all MCOs. We did not find any disparities by demographics based on formulary restrictions, within the Medicaid population.