{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T01:30:42Z","timestamp":1778895042623,"version":"3.51.4"},"reference-count":35,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2016,11,20]],"date-time":"2016-11-20T00:00:00Z","timestamp":1479600000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["1R01HS0119669"],"award-info":[{"award-number":["1R01HS0119669"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2018,2]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To examine changes in children's albuterol use and out\u2010of\u2010pocket (<jats:styled-content style=\"fixed-case\">OOP<\/jats:styled-content>) costs in response to increased copayments after the Food and Drug Administration banned inhalers with chlorofluorocarbon (<jats:styled-content style=\"fixed-case\">CFC<\/jats:styled-content>) propellants.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Four health maintenance organizations (<jats:styled-content style=\"fixed-case\">HMO<\/jats:styled-content>s), two that increased copayments for albuterol inhalers that went from generic <jats:styled-content style=\"fixed-case\">CFC<\/jats:styled-content>\u2010containing to branded <jats:styled-content style=\"fixed-case\">CFC<\/jats:styled-content>\u2010free versions, and two that retained generic copayments for <jats:styled-content style=\"fixed-case\">CFC<\/jats:styled-content>\u2010free inhalers (controls). We included children with asthma aged 4\u201317\u00a0years with commercial coverage from 2007 to 2010.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Interrupted time series with comparison series.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data<\/jats:title><jats:p>We obtained enrollee and plan characteristics from enrollment files, and utilization data from pharmacy and medical claims; <jats:styled-content style=\"fixed-case\">OOP<\/jats:styled-content> expenditures were extracted from pharmacy claims for two <jats:styled-content style=\"fixed-case\">HMO<\/jats:styled-content>s with cost data available.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>There were no significant differences in albuterol use between the group with increased cost\u2010sharing and controls with respect to changes after the policy change. There was a postpolicy increase of $6.11 <jats:styled-content style=\"fixed-case\">OOP<\/jats:styled-content> per month per child using albuterol among those with increased cost\u2010sharing versus $0.36 in controls; the difference between groups was significant (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Increased copayments for brand\u2010name <jats:styled-content style=\"fixed-case\">CFC<\/jats:styled-content>\u2010free albuterol after the <jats:styled-content style=\"fixed-case\">CFC<\/jats:styled-content> ban did not lead to a decrease in children's albuterol use, but it led to a modest increase in <jats:styled-content style=\"fixed-case\">OOP<\/jats:styled-content> costs.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1475-6773.12615","type":"journal-article","created":{"date-parts":[[2016,11,21]],"date-time":"2016-11-21T03:42:41Z","timestamp":1479699761000},"page":"156-174","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Impact of Copayment Changes on Children's Albuterol Inhaler Use and Costs after the Clean Air Act Chlorofluorocarbon Ban"],"prefix":"10.1111","volume":"53","author":[{"given":"Alison A.","family":"Galbraith","sequence":"first","affiliation":[{"name":"Center for Healthcare Research in Pediatrics Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute Boston MA"},{"name":"Division of General Pediatrics Boston Children's Hospital Boston MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vicki","family":"Fung","sequence":"additional","affiliation":[{"name":"Mongan Institute Massachusetts General Hospital Boston MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lingling","family":"Li","sequence":"additional","affiliation":[{"name":"Sanofi Genzyme Cambridge MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa G.","family":"Butler","sequence":"additional","affiliation":[{"name":"Roivant Sciences Hamilton Bermuda"},{"name":"Center for Clinical and Outcomes Research Kaiser Permanente Georgia Atlanta GA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James D.","family":"Nordin","sequence":"additional","affiliation":[{"name":"HealthPartners Institute Minneapolis MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Hsu","sequence":"additional","affiliation":[{"name":"Mongan Institute Massachusetts General Hospital Boston MA"},{"name":"Department of Health Care Policy Harvard Medical School Cambridge MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Smith","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Center for Health Research Northwest Portland OR"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William M.","family":"Vollmer","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Center for Health Research Northwest Portland OR"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tracy A.","family":"Lieu","sequence":"additional","affiliation":[{"name":"Division of Research Kaiser Permanente Northern California Oakland CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen B.","family":"Soumerai","sequence":"additional","affiliation":[{"name":"Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute Boston MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ann Chen","family":"Wu","sequence":"additional","affiliation":[{"name":"Center for Healthcare Research in Pediatrics Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute Boston MA"},{"name":"Division of General Pediatrics Boston Children's Hospital Boston MA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,11,20]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0168-8510(02)00158-6"},{"issue":"10","key":"e_1_2_7_3_1","first-page":"703","article-title":"Increasing Pharmaceutical Copayments: Impact on Asthma Medication Utilization and Outcomes","volume":"17","author":"Campbell J. D.","year":"2011","journal-title":"American Journal of Managed Care"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-008-0614-0"},{"key":"e_1_2_7_5_1","unstructured":"Consumer Affairs.2009. \u201cHFA Inhalers: Consumer Complaints & Reviews\u201d [accessed on December 7 2015]. Available athttp:\/\/www.consumeraffairs.com\/health\/hfa_inhalers.html?page=13"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinthera.2008.06.003"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e318190d482"},{"issue":"7","key":"e_1_2_7_8_1","first-page":"649","article-title":"Financial Barriers to Care among Low\u2010Income Children with Asthma: Health Care Reform Implications","volume":"168","author":"Fung V.","year":"2014","journal-title":"Journal of the American Medical Association Pediatrics"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2010.0584"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-011-1970-8"},{"issue":"11","key":"e_1_2_7_11_1","first-page":"730","article-title":"The Effects of Prescription Drug Cost Sharing: A Review of the Evidence","volume":"11","author":"Gibson T. B.","year":"2005","journal-title":"American Journal of Managed Care"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.298.1.61"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.291.19.2344"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e3181734a77"},{"issue":"7","key":"e_1_2_7_15_1","first-page":"1171","article-title":"The Impact of the US Food and Drug Administration Chlorofluorocarbon Ban on Out\u2010of\u2010Pocket Costs and Use of Albuterol Inhalers among Individuals with Asthma","volume":"175","author":"Jena A. B.","year":"2015","journal-title":"Journal of the American Medical Association Internal Medicine"},{"issue":"1","key":"e_1_2_7_16_1","first-page":"103","article-title":"The Impact of Increasing Patient Prescription Drug Cost Sharing on Therapeutic Classes of Drugs Received and on the Health Status of Elderly HMO Members","volume":"32","author":"Johnson R. E.","year":"1997","journal-title":"Health Services Research"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2012.1137"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.340"},{"issue":"7","key":"e_1_2_7_19_1","first-page":"897","article-title":"Income\u2010Based Drug Benefit Policy: Impact on Receipt of Inhaled Corticosteroid Prescriptions by Manitoba Children with Asthma","volume":"165","author":"Kozyrskyj A. L.","year":"2001","journal-title":"Canadian Medical Association Journal"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.82.5.703"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.93.10.1655"},{"issue":"10","key":"e_1_2_7_22_1","first-page":"621","article-title":"Impact of 3\u2010Tier Pharmacy Benefit Design and Increased Consumer Cost\u2010Sharing on Drug Utilization","volume":"11","author":"Landsman P. B.","year":"2005","journal-title":"American Journal of Managed Care"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwt323"},{"key":"e_1_2_7_24_1","unstructured":"2008 St. Louis Post Dispatch K. McGuire \u201cGreen' Device Is Mandated for People and Planet. New Inhalers Are Ozone\u2010Safe but They Cost More and Operate Differently"},{"key":"e_1_2_7_25_1","volume-title":"Free for All? Lessons from the RAND Health Insurance Experiment","author":"Newhouse JP and the Insurance Experiment Group","year":"1993"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.94.10.1782"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlr.0000178216.23514.b7"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.285.4.421"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201306-1017OC"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpediatrics.2007.21"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anai.2010.10.006"},{"key":"e_1_2_7_32_1","unstructured":"United States Bureau of Labor Statistics.2016. \u201cArchived Consumer Price Index Detailed Report Information\u201d [accessed on February 20 2016]. Available athttp:\/\/www.bls.gov\/cpi\/cpi_dr.htm#2010"},{"issue":"63","key":"e_1_2_7_33_1","first-page":"17167","article-title":"Use of Ozone\u2010Depleting Substances; Removal of Essential\u2010Use Designations; Final Rule. 21 CFR Part 2","volume":"70","author":"United States Food and Drug Administration","year":"2005","journal-title":"New England Journal of Medicine"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2710.2002.00430.x"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2014.05.009"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201410-459OC"}],"container-title":["Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2F1475-6773.12615","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2F1475-6773.12615","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1475-6773.12615","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,24]],"date-time":"2023-09-24T10:59:20Z","timestamp":1695553160000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1475-6773.12615"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,11,20]]},"references-count":35,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2018,2]]}},"alternative-id":["10.1111\/1475-6773.12615"],"URL":"https:\/\/doi.org\/10.1111\/1475-6773.12615","archive":["Portico"],"relation":{},"ISSN":["0017-9124","1475-6773"],"issn-type":[{"value":"0017-9124","type":"print"},{"value":"1475-6773","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,11,20]]},"assertion":[{"value":"2016-11-20","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}