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Item refines Peer-reviewed Added

COPD inhalers after British Columbia removed prior authorisation for first-line therapy

In 47,583 people with COPD, removing prior authorisation for LAMA preceded 0.8% more LAMA use and 1.3% less ICS/LABA use.

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
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

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