Medicaid asthma-related prescription fills and the associated program expenditures for individuals who had a current diagnosis of asthma and an ambulatory service in CY 2002 using the HHS/NIH/NHLBI NAEPP guidelines: Age, gender, and race/ethnicity variations

The goal of this study was to examine the extent to which Medicaid-covered enrollees who had a reported ICD-9 493 diagnosis of asthma during 2002 also had filled asthma-related prescriptions; and, associated program expenditures. The research also examined variations by age groups, gender and race/ethnicity, reporting rates, odds ratios and relative risk. It is well recognized that asthma is one of the most common chronic conditions among all age groups and that medications are important factors in preventing and treating asthma attacks. The HHS/NIH/NHLBI National Asthma Education and Prevent Program clinical guidelines call for asthma-related medication use to prevent or control attacks. The NAEPP recognizes the list of NDC codes that we used to select these medications. The study database was the CMS Medicaid Analytic eXtract (MAX) enrollment and health care and prescription claims. Encounter claims were excluded because of serious underreporting. Overall, nearly 90% of enrollees with a claim for any asthma service had an asthma-related prescription filled. This analysis was on a subset these claims, specifically the national universe of fee-for-service and primary care case management claims. Findings showed that 1.4+ million enrollees received 5.7+ million ambulatory asthma care services. More than 1.2+ million enrollees had 8.6+ million asthma-related prescription fills (average =7 per enrollee). Program expenditures for the ambulatory care exceeded $281 million and $515 million for asthma-related prescription fills. Children accounted for 62% of the individuals with a diagnosis of asthma who also had an asthma-related prescription fill, but only 44% of the asthma-related prescription fill claims; and 44% of associated claim expenditures. Blacks accounted for 28% of individuals with an asthma-related prescription fills and received 26 % of the asthma-related prescription fill claims and 24 % of claim expenditures. Children accounted for 62% of the individuals with asthma who also had an asthma-related ambulatory service. They received 52 % of the asthma-related ambulatory services accounting for 54 % of associated expenditures. Blacks accounted for 28% of individuals with asthma who also had asthma-related ambulatory care. They received 28 % of the asthma-related ambulatory service accounting for 31% of associated claim expenditures. Race/ethnicity disparities were evident throughout the analyses.