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If We Prescribe It, Will It Come?
Access to Asthma Equipment for Medicaid-Insured Children and Adults in the Bronx, NY
Karen L. Warman, MD;
Amanda M. Jacobs, MD;
Ellen J. Silver, PhD
Arch Pediatr Adolesc Med. 2002;156:673-677.
Context Asthma is a major cause of morbidity in the United States. Self-management
of asthma requires access to appropriate equipment. Clinical experience in
an inner-city practice suggests that families encounter difficulties in filling
prescriptions for spacers/holding chambers, peak flow (PF) meters, and nebulizer
machines.
Objectives To determine whether Bronx, NY, pharmacies (1) carry spacers/holding
chambers, PF meters, and nebulizer machines; (2) accept Medicaid insurance
for them; and (3) perceive barriers to reimbursement by Medicaid for this
equipment.
Design and Setting Structured telephone survey of 100 Bronx pharmacies randomly selected
from the1999 telephone directory.
Participants Ninety-eight pharmacists and 2 pharmacy technicians in 100 different
pharmacies.
Main Outcome Measures Pharmacists' reports of equipment availability, Medicaid acceptance,
and reasons for not carrying equipment or accepting Medicaid.
Results Overall equipment availability was as follows: spacers (68%), spacers
with masks (57%), adult PF meters (40%), child-range PF meters (24%), and
nebulizer machines (56%). For Medicaid recipients, equipment was less available:
spacers (45%), spacers with masks (35%), adult PF meters (27%), child-range
PF meters (17%), and nebulizer machines (33%). Surveyed pharmacists reported
misconceptions about requirements for Medicaid reimbursement, which included
the following: that Durable Medical Equipment permits are required (64% spacers
and 33% PF meters), that special forms are needed (17% PF meters), or that
this equipment is not covered by Medicaid (14% spacers and 8% PF meters).
Of the 100 surveyed pharmacists, 32 reported difficulties with Medicaid reimbursement
and 41 had never tried to receive reimbursement.
Conclusions These results suggest that (1) access to spacers/holding chambers, PF
meters, and nebulizers for Medicaid-insured families is severely limited in
Bronx pharmacies; (2) misunderstandings regarding Medicaid reimbursement policies
are common; and (3) interventions to increase the proportion of pharmacies
that dispense equipment are needed.
From the Department of Pediatrics, Children's Hospital at Montefiore,
Albert Einstein College of Medicine, Bronx, NY.
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