Trends in utilization, expenditure, and average reimbursement per claim of chronic obstructive pulmonary disease-specific medications in the United States Medicaid program (2008–2023)

Abstract Background Chronic obstructive pulmonary disease (COPD) is a major global health burden, affecting 300–400 million people worldwide and ranking as the fifth leading cause of death in the United States. Limited evidence exists regarding long-term trends in the utilization, expenditure, and average reimbursement per prescription of COPD therapies in the US Medicaid population. Objectives To evaluate a 16-y trend in utilization, reimbursements, and average reimbursement per prescription of COPD medications reimbursed by Medicaid, emphasizing the impact of newer long-acting and combination inhalers. Methods Medicaid State Drug Utilization data were analyzed from 2008 to 2023 in this retrospective observational study. Medications were included if they had an FDA-approved labeling for COPD only, yielding seven therapeutic classes. Annual claims count, expenditures, and average reimbursement per claim were assessed. Trend significances were evaluated using the Mann–Kendall test. Also, the rate of prescription claims per 1000 full-year-equivalent (FYE) Medicaid enrollees was evaluated. Results A total of 92.9 million prescriptions were dispensed from 2008 to 2023. SABA+SAMA combination dominated utilization by 36.1 million claims followed by LAMA (32 M) and SAMA (16.2 M). Prescription claims increased from 3.1 million to 5.8 million claims between 2008 and 2023, while Medicaid spending rose from $472 million to $1.78 billion. The average costs per prescription also rose from $152 to $306 over the same period. Prescription claims per 1000 FYE enrollees rose from 63.2 to 97.2 between FY2008 and FY 2016, then fell to 60 in FY2023. Conclusions COPD treatment in the U.S. Medicaid program shifted toward long-acting and combination bronchodilator therapies. Medicaid expenditure and average prescription per claim rose over the study period. Yet, reimbursements decreased after 2020, and utilization per 1000 FYE enrollee had returned to its 2008 level by 2023.