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# COPD inhalers after British Columbia removed prior authorisation for first-line therapy
- URL: https://www.coios.me/copd-inhalers-after-british-columbia-removed-prior/
- Published: 2026-11-08T13:05:01.000Z
- Updated: 2026-11-08T14:09:01.000Z
- Description: In 47,583 people with COPD, removing prior authorisation for LAMA preceded 0.8% more LAMA use and 1.3% less ICS/LABA use.
- Author: Daniel Ryan
- Tags: Behavioural science, Adherence and persistence, Canada, #peer-reviewed, #refines, #item, #source-2026-11, #score-65

In July 2020, British Columbia removed prior authorisation for long-acting muscarinic antagonists (LAMA) and restricted inhaled corticosteroid/long-acting beta-agonist (ICS/LABA) cover. Interrupted time series analysis followed 47,583 patients with chronic obstructive pulmonary disease (COPD) in provincial administrative data, 2019–2022\. At 30 months, ICS/LABA use was 1.3% lower and LAMA use 0.8% higher than the counterfactual. LAMA proportion of days covered rose by 1.5%, and starting LAMA as first maintenance therapy rose by 34.8%. ICS/LABA discontinuation and total combined drug costs did not change. The design is observational, so these changes are associations rather than proven effects of the policy.

*Why it is interesting: Removing prior authorisation for LAMA, the guideline first-line inhaler, was associated with more LAMA use and less ICS/LABA use. Total combined drug costs did not change, though ICS/LABA discontinuation was unaffected.*

Source

[CHEST, 5 November 2026](https://doi.org/10.1016/j.chest.2026.10.035?ref=coios.me)

Paper

The impact of removing prior authorization for guideline-concordant maintenance inhaled medications for COPD: a population-based cohort study

Authors

Johnson KM, Cheng L, Duan KI, Law MR

DOI

10.1016/j.chest.2026.10.035

Type

Peer-reviewed article

Design

Population-based cohort with interrupted time series, 47,583 COPD patients, British Columbia administrative data, Jan 2019–Dec 2022 (18 months pre, 30 months post policy)

Verdict

Refines prior evidence

Driver

[Adherence and persistence](https://www.coios.me/d-adherence/)