Where Insurance Meets Clinical Practice for COPD

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The MD Magazine Peer Exchange “Expanding Treatment Options: The Latest Developments in COPD Therapy” features a panel of physician experts discussing key topics in COPD therapy, including risk factors, personalized treatment, preventive measures, new combination therapies, and more.

This Peer Exchange is moderated by Peter Salgo, MD, professor of medicine and anesthesiology at Columbia University and an associate director of surgical intensive care at the New York-Presbyterian Hospital in New York City.

The panelists are:

• Byron Thomashow, MD, professor of medicine at Columbia University Medical Center, medical director at the Jo-Ann LeBuhn Center for Chest Disease at New York-Presbyterian Hospital, and chairman of the board of the COPD Foundation
• Neil R. MacIntyre, MD, clinical chief of the Pulmonary/Critical Care Division, medical director of Respiratory Care Services, and professor of medicine at Duke University School of Medicine
• Barry J. Make, MD, director of Pulmonary and Respiratory Care for National Jewish Health and professor of medicine at the University of Colorado School of Medicine
• Nicola A. Hanania, MD, MS, associate professor of medicine and director of the Asthma and COPD Clinical Research Center at Baylor College of Medicine

When it comes to COPD treatment policy decisions made by insurance companies, Thomashow said that, unfortunately, are not aligned with ideal patient care. For example, insurance companies have decided that all drugs within the same drug class are equivalent, which is not the case. When a patient is not able to procure the prescribed medication because it is not covered, there is added burden for both the patient and the physician, said Make.

Speaking of burden, Thomashow said that patients with COPD tend to have several comorbidities, requiring many different medications, which may make it unlikely that they will comply with all of them, foregoing their inhaler for the medications that treat other comorbidities.

As for route of administration, according to MacIntyre, the aerosol route is probably more desirable than oral. Dry powder inhalers require a certain inspiratory flow rate, but patients do not have as many coordination issues with them as with metered dose inhalers, which have spacers to slow the inspiratory flow down. The newest metered dose inhaler, RESPIMAT, creates a liquid aerosol but without velocity, which confers an advantage. But many of the choices will be forced by what insurance companies will approve, he said.