Why Medicaid Programs Should Cover MART for Asthma
Accelerating Access
to Maintenance and
Reliever Therapy (MART)
2025
Acknowledgements
This study was made possible through a grant from the American Lung Association (ALA). The views expressed in this policy brief are those of the authors and do not necessarily relfect those of the ALA.
Special thanks to our Tableau team: Ted Floros, adjunct professor of Tableau at WashU and his students, Biruk Denma and Kaleb Urga.
This policy brief was made possible through a grant from the American Lung Association (ALA).
Asthma results in $80 billion in cost in the United States annually.
1 in 10 children in
the U.S. have been diagnosed with asthma.
We recommend all states:
Executive summary
Maintenance and Reliever Therapy (MART) is a guideline-recommended treatment strategy for moderate-to-severe asthma that uses a single budesonide-formoterol inhaler for both daily (maintenance) and as-needed (reliever) use. This evidence-based treatment strategy reduces the risk patients will experience a severe asthma attack by about one-third, yet remains underused.
We recommend that all payors ensure: (1) budesonide-formoterol is included on preferred drug formularies, (2) that coverage allows for at least two budesonide-formoterol refills monthly to support both maintenance and reliever use, (3) and that this inhaler is available with minimal out-of-pocket costs to patients.
About MART
Asthma facts
Cover at least 2 budesonide-formoterol inhalers monthly.
Cover the cost of budesonide-formoterol with minimal or no co-pay.
Place budesonide-formoterol on their preferred drug formulary.
26 million Americans have been diagnosed with asthma.
MART is preferred by patients and described as simpler to use.
MART leads to a 30% decrease in asthma exacerbations.
MART is guideline-recom-mended and recommended by asthma experts.
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Khadijah Kareem, BA
Design researcher at HCDS at the Sam Fox School of Design & Visual Arts
Nicole Chen, BA
Design researcher at HCDS at the Sam Fox School of Design & Visual Arts
Hannah Kim, BFA
Graphic designer, illustrator at HCDS at the Sam Fox School of Design &
Visual Arts
Christine Watridge, BA
Program coordinator of HCDS at the Sam Fox School of Design &
Visual Arts
Health communication design
Chinmay Joshi
Health policy research assistant
Tri Pham, MD
Medicine resident at Washington University School of Medicine
Mark Huffman, MD MPH
William Bowen endowed professor of medicine,
co-director of the Global Health Center at Washington University in St. Louis
Sarah Eisenstein, PhD
Statistical analyst at Washington University in St. Louis
Joshua Moore, PharmD
Pharmacy director at MO HealthNet division (Missouri Medicaid).
Timothy McBride, PhD, MS
Becker professor, co-director of "Center for Advancing Health Services, Policy
& Economics Research" (CAHSPER) at Washington University in St. Louis
Abigail Barker, PhD
Research-associate professor associate director of policy partnerships at CAHSPER at Washington University in
St. Louis
Ross Brownson, PhD
Lipstein distinguished professor, director of the Prevention Research Center at Washington University School of Public Health
Health economics and policy
Krutika Chauhan, MBBS, MPH, CPH
Research supervisor
of "A Collaboration with Community Health Center to Implement SMART for Asthma" (CHEST) Study
Mario Castro, MD, MPH
Division chief of pulmonary, critical care and sleep medicine at the University of Kansas Medical Center
Anna Volerman, MD, MPH
Associate professor of medicine and pediatrics at the University of Chicago School of Medicine
Anne Dixon, MA, BM, BCh Professor of medicine at University of Vermont School of Medicine, chairwoman of medicine of the Vermont Lung Center
Asthma management
We are a multidisciplinary team united in our goal of advocating for better access to guideline-recommended asthma care that could improve the health of asthma patients. By leveraging diverse expertise across pulmonary medicine, primary care, pediatrics, public health, pharmacy, policy research, and health communication, we aim to reduce disparities and improve asthma outcomes. Our members include:
About the team
Penina Laker, MFA
Director of the Health Communication Design Studio (HCDS), associate professor of design at Washington University in St. Louis
Kaharu Sumino, MD, MPH Professor of medicine at Washington University School of Medicine
Lynn Gerald, PhD, MSPH
Assistant vice chancellor for population health sciences
at the University of Illinois Chicago School of Medicine
James Krings, MD, MSc
Assistant professor of medicine in pulmonary and critical care at Washington University School of Medicine
The burden of asthma disproportionately affects different communities in the U.S. The American Lung Association (ALA) noted in a recent publication that asthma is more prevalent among people covered by Medicaid compared to those with private insurance (12.4% vs. 7.2%, respectively). Moreover, people covered by Medicaid are more likely to seek emergency care for their asthma and require hospitalization for asthma. Patients who identify as Black or African American are more likely to develop asthma and more likely to visit the emergency room for asthma-related issues. Despite repeated efforts, inequities in asthma outcomes have not meaningfully narrowed in the last 30 years.
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94,560
hospitalizations
4.9 million
doctor visits
13.8 million
missed school days
986,453
emergency room visits
Each year asthma causes…
40%
Asthma is the second-most common chronic respiratory disease in the United States (U.S.), affecting one in 12 people. Asthma is a chronic inflammatory disorder characterized by episodes of wheezing, coughing, and shortness of breath due to narrowing of the airways. Each year, approximately 40% of adults and children with asthma experience one or more severe asthma exacerbations, which leads to nearly 1 million emergency room visits and 3,500 deaths annually. The economic burden of asthma is substantial: the cost attributed to asthma exceeds $80 billion U.S. dollars (U.S.D.) each year.
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Asthma in the United States
With MART,
everyday and rescue
inhalers are the same!
Rescue inhaler
Everyday inhaler
To increase ICS exposure through the vehicle of a reliever inhaler, asthma researchers began exploring a treatment paradigm wherein patients are instructed to use a single inhaler containing both a fast-acting reliever beta-agonist (specifically, formoterol) combined with an inhaled corticosteroid to be used on a maintenance and reliever basis.4 This inhaler strategy is now termed “single maintenance and reliever therapy” (SMART) or “maintenance and reliever therapy” (MART) and is recommended by both experts from the Global Initiative for Asthma (GINA)3 and the National, Heart, Lung, and Blood Institute’s National Asthma Education and Prevention Program (NAEPP).2
Expert recommendations and national guidelines for asthma management have recently undergone a paradigm shift. Traditionally, experts recommended that patients with persistent asthma be prescribed both a maintenance inhaler containing an inhaled corticosteroid (ICS) and a separate short-acting beta-agonist (SABA; such as albuterol) for as-needed symptomatic relief.17 However, many patients in the real-world inconsistently use their maintenance ICS inhalers, instead relying solely, or primarily, on SABA relievers like albuterol.17 Maintenance ICS inhaler non-adherence is strongly and directly associated with worse asthma outcomes.18-20 Some studies have shown that patients covered by Medicaid have lower rates of maintenance ICS inhaler adherence and are more likely to rely on frequent SABA utilization.21,22
Guidelines in asthma now advocate for the use of single maintenance and reliever therapy (or MART). Greater access to guideline-directed care could improve outcomes and reduce healthcare costs.
Changes in guideline recommendation for
MART prescription
–47-year-old Missouri resident with
asthma who tried MART
“I like the combined approach [MART therapy] better because I forget to take my [everyday inhaler] so much. And I don’t forget to take my rescue inhaler because my body tells me when I need it.”
Based on repeated clinical trials that have collectively enrolled over 22,000 asthma patients, MART has been found to be superior to conventional asthma treatment paradigms.7,23 In a recent meta-analysis, use of MART (as compared to treatment paradigms containing a maintenance ICS-containing inhaler plus SABA reliever inhaler) was associated with an approximately one-third reduction in severe asthma exacerbation risk (relative risk 0.68 [95% CI 0.58 to 0.80]; annualized exacerbation difference of -6.4% [95% CI -10.2% to -2.6%], I2=29%, 15 trials, 22,748w participants).24
In addition to being guideline-recommended, patients have reported that MART is simpler to use and increases their self-efficacy (or the control they feel over their asthma).5 On a day-to-day basis, MART is associated with similar asthma symptoms. However, patients have the added benefit of only needing to refill and actuate one inhaler type rather than two different inhalers – one for maintenance usage and one for reliever usage.
Evidence shows that utilization of MART decreases a patient’s risk of experiencing a severe asthma exacerbation and is preferred by patients.
GINA (Global Initiative for Asthma) 2025 recommendations for the management of individuals at least 12 years old with asthma. GINA 2025, reproduced with permission. Available from www.ginasthma.org.
and mometasone-formoterol.25 The vast majority of data supporting utilization of MART took place in studies utilizing budesonide-formoterol, and as such this is the only U.S.-based inhaler that is clearly recommended by both GINA and the NAEPP for MART. Mometasone-formoterol is considered a reasonable alternative for MART utilization by some experts but data supporting this indication
is extrapolated.
Based on the aforementioned data demonstrating both the efficacy and safety of MART, since 2019 and 2020, respectively, both GINA and the NAEPP have recommended MART.2,3 MART requires utilization of an inhaler containing both an ICS and formoterol together as formoterol is a long-acting beta-agonist that has a rapid onset of action, which is necessary for quick symptomatic relief. In the U.S., two current ICS-formoterol combination inhalers are commercially available: budesonide-formoterol
Both GINA and the NAEPP strongly recommend that clinicians preferentially prescribe MART to patients with moderate-to-severe asthma.
Guideline recommendations for MART
Given the fact that patients prescribed MART for GINA step 4-5 therapy require utilization of 2 inhalations of budesonide-formoterol twice daily plus as-needed, they could deplete their 120-actuation budesonide-formoterol inhaler before the end of the month.26 Furthermore, both adults and children with asthma may need to place one budesonide-formoterol inhaler in another location to have available for rescue utilization. As such, with MART, it is of paramount importance that healthcare payors cover at least two budesonide-formoterol inhalers each month for optimal coverage of guideline-recommended care.
GINA-recommended inhalers and dosing for MART in adolescents and adults aged 12 years and older:
Steps 1–2 (AIR-only): 1 inhalation as needed
Step 3: MART: budesonide-formoterol 160- 4.5µg 1 inhalation twice (or once) daily plus 1 as needed
Step 4: MART: budesonide-formoterol 160- 4.5µg 2 inhalations twice daily plus 1 as needed
Step 5: MART: budesonide-formoterol 160- 4.5µg 2 inhalations twice daily plus 1 as needed
Steps 1–2 (Anti-Inflammatory Reliever (AIR)-only): no evidence to date
Step 3: MART: budesonide-formoterol 80-
4.5µg 1 inhalation once daily plus 1 as needed
Step 4: MART: budesonide-formoterol 80-4.5µg 1 inhalation twice daily plus 1 as needed
Step 5: MART: not recommended
GINA-recommended inhalers and dosing for MART in adolescents 6 to 11 years old:
In their 2024 Global Strategy for Asthma Management and Prevention report, GINA currently recommends the following SMART dosing strategies, which vary based on both the patient’s age and disease severity.3
“I like the combined approach [MART therapy] better because I forget to take my [everyday inhaler] so much. And I don’t forget to take my rescue inhaler because my body tells me when I need it.”
–Anne Dixon, MA, BM, BCh
How to cover MART in my state
Coverage of guideline-recommended MART also has other notable nuances. For people who have more severe asthma (that warrants NAEPP step 4 or GINA step 4-5 therapy), it is recommended that they take 2 inhalations of budesonide-formoterol twice daily and 1 puff as-needed for asthma symptoms.3 As such, with any reliever usage of their budesonide-formoterol inhaler they will deplete their 120-actuation budesonide-formoterol inhaler before the end of the month. It is of the utmost importance that PBMs cover at least two ICS-formoterol inhalers each month for a patient to utilize MART as the guidelines recommend. As of April 2023, 33 states imposed quantity limits on budesonide-formoterol and mometasone-formoterol that are more restrictive than three inhalers per month.29 The most recent NAEPP guidelines stress the importance of allowing an adequate supply of inhalers and not limiting prescriptions to just one metered-dose inhaler.
Despite robust evidence demonstrating the efficacy of MART at preventing asthma exacerbations and its place in national asthma guidelines, most patients are still not prescribed MART. Based on one retrospective study at a large academic medical center, less than 15% of patients with moderate-to-severe asthma were prescribed MART.27
Clinicians have explained that the fundamental barrier to prescribing MART in the U.S. is that pharmacy benefit managers (PBMs) do not universally include budesonide-formoterol inhalers on their preferred drug formularies, making them financially inaccessible for many U.S. patients.28 MART requires utilization of formoterol as its LABA component due to formoterol’s rapid onset of action, which is essential for quick symptomatic relief. However, many PBMs do not recognize that ICS-formoterol inhalers are thus fundamentally different from other ICS-LABA inhalers containing slower-onset LABAs such as salmeterol and vilanterol.4 Combination inhalers not containing formoterol should not be used
with MART.
“I like the combined approach [MART therapy] better because I forget to take
my [everyday inhaler] so much. And I don’t forget to take my rescue inhaler because my body tells me when I need it.”
–GINA representative
Despite the strong evidence and national guidelines supporting MART, it is still infrequently prescribed.
At the expected budesonide-formoterol cost of $187 per inhaler, MART was cost
savings to payors in 57% of simulations due to prevented downstream asthma-related morbidity. Click below to estimate the probability MART is cost savings based on different costs of inhalers.
The cost savings associated with coverage of MART over traditional inhaler therapy occurred over a one-year time horizon. Furthermore, these cost analyses did not consider the broader economic impacts of asthma morbidity and mortality. MART is likely associated with even greater cost savings when a societal view is considered, as patients who receive MART experience fewer severe asthma exacerbations, and thus likely experience less school and work absenteeism and fewer productivity losses, which are estimated to cost $3 billion annually.31
Based on a recent analysis, U.S. healthcare payors would generally experience lower cumulative
asthma management costs if asthma patients received MART as opposed to traditional inhaler therapy.30 The average per-patient savings if a patient was prescribed MART versus traditional inhaler therapy was $17 U.S.D. to $138 U.S.D. MART was associated with a higher cost for medication refills; however, this higher medication cost was generally more than offset by the cost savings to healthcare payors from prevented healthcare costs associated with asthma morbidity (e.g., emergency room costs and inpatient hospitalizations).
MART is less costly to United States’ healthcare payors versus traditional inhaler therapy as it prevents expensive downstream medical costs.
What’s the cost of covering MART?
An interactive calculator that determines the probability MART will save costs for healthcare payor. Input “budesonide formoterol costs” and cost savings probability will be calculated.
MO HealthNet, Missouri’s Medicaid program, began covering budesonide-formoterol (MART) for moderate-to-severe patients with asthma with the stated goal of increasing the percentage of patients using appropriate asthma controllers.32 It released a flyer for providers highlighting budesonide-formoterol and mometasone-formoterol as preferred therapies for maintenance and reliever that do not require prior authorization. It covered 3 inhalers per month. It released a clinical update aimed to limit SABA overuse. Coverage of SABAs without prior authorization were limited to 3 inhaler canisters every 6 months for adults.
MO HealthNet SMART Coverage
Example Implementation
A case study in MART utilization
Coverage of MART within Medicaid by state in 2024
Your program/Medicaid Programs could save on costs associated with asthma
Based on a recent analysis, payors would save $17 to $138 per patient prescribed MART versus traditional inhaler therapy.
MART decreases the likelihood that a patient will have a severe asthma exacerbation and require expensive acute asthma care.
Patients would receive a simpler inhaler regimen
Patients prefer MART over traditional inhaler therapy, as patients have told researchers that it is easier to learn only one inhaler type as compared to two.
Budesonide-formoterol and mometasone-formoterol inhalers can be used with a spacer device.
Guideline-recommended asthma therapy would be covered
Guidelines from both GINA and the National Institute of Health’s NAEPP preferentially recommend MART for
all patients with moderate-to-
severe asthma.
Improvements would occur in
asthma morbidity
Repeated clinical trials show that MART reduces the occurrence of severe asthma exacerbations that result in prescriptions of systemic corticosteroids, emergency department visits, and hospitalizations.
What happens if MART is covered in my state?
High utilization of albuterol is associated with adverse outcomes in asthma.
Flagging high albuterol use at the point of inhaler dispensing and advising discussion with providers and users could help limit albuterol use.
See "What happens if MART is covered in my state?" for Missouri Medicaid’s (MO HealthNet) experience with albuterol quantity limits.
Consider limiting albulterol refills without prior authorization:
Prior authorizations and extra paperwork increase the burden on providers and patients, and studies have shown that they limit access to guideline-recommended care.
When able, payors should streamline processes for MART dispensing.
Streamline prior authorization processes when possible:
Although MART is guideline-recommended and evidence-based, it is a new treatment regimen for many healthcare providers and patients.
Supporting education on MART in your state could promote awareness of the latest guideline-recommended asthma therapy and realize potential cost savings.
Promote provider-level and patient-level education on MART:
Other actions your state should consider…
Studies have demonstrated that high out-of-pocket inhaler costs limit dispensing33, worsen asthma outcomes33, and may widen healthcare disparities.34
As such, we recommend limiting patients’ out-of-pocket expenses for MART to the degree
financially possible.
Limit out-of-pocket expenses for inhalers:
MART requires utilizing a budesonide-formoterol inhaler for both maintenance and reliever use. Therefore, patients may require more than one budesonide-formoterol inhaler per month to follow MART guidelines (see p. 10).
We recommend all payors cover 2-3 budesonide-formoterol inhalers each month to allow for maintenance and reliever usage.
Cover at least 2 budesonide-formoterol inhalers each month:
MART requires formoterol as the LABA component due to formoterol’s quick onset, which is necessary for symptom relief.
Most studies of MART evaluated budesonide-formoterol; while no studies to date have evaluated the use of mometasone-formoterol in MART, it is likely also effective for MART.
Given the current evidence, we recommend all states place budesonide-formoterol on their preferred drug list.
Preferentially cover budesonide-formoterol:
What do we recommend in your state
1. Asthma Statistics - Allergy & Asthma Network. Accessed June 25, 2025. https://allergyasthmanetwork.org/what-is-asthma/asthma-statistics/
2. 2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group | NHLBI, NIH. Accessed June 25, 2025. https://www.nhlbi.nih.gov/resources/2020-focused-updates-asthma-management-guidelines
3. Reports - Global Initiative for Asthma - GINA. Accessed June 25, 2025. https://ginasthma.org/reports/
4. Krings JG, Sekhar TC, Chen V, et al. Beginning to Address an Implementation Gap in Asthma: Clinicians’ Views of Prescribing Reliever Budesonide-Formoterol Inhalers and SMART in the United States. J Allergy Clin Immunol Pract. 2023;11(9):2767-2777. doi:10.1016/J.JAIP.2023.05.023
5. Foster J, Beasley R, Braithwaite I, et al. Perspectives of mild asthma patients on maintenance versus as-needed preventer treatment regimens: A qualitative study. BMJ Open. 2022;12(1). doi:10.1136/BMJOPEN-2020-048537,
6. Cardet JC, Papi A, Reddel HK. “As-Needed” Inhaled Corticosteroids for Patients With Asthma. Journal of Allergy and Clinical Immunology: In Practice. 2023;11(3):726-734. doi:10.1016/j.jaip.2023.01.010
7. Beasley R, Harrison T, Peterson S, et al. Evaluation of Budesonide-Formoterol for Maintenance and Reliever Therapy among Patients with Poorly Controlled Asthma: A Systematic Review and Meta-analysis. JAMA Netw Open. 2022;5(3). doi:10.1001/JAMANETWORKOPEN.2022.0615,
8. Asthma Facts. Accessed June 25, 2025. https://aafa.org/asthma/asthma-facts/
9. Most Recent National Asthma Data | CDC. Accessed June 25, 2025. https://www.cdc.gov/asthma/most_recent_national_asthma_data.htm
10. Asthma-Related Health Care Use Data 2020 | CDC. Accessed June 25, 2025. https://www.cdc.gov/asthma/healthcare-use/2020/data.htm
11. Facts and Stats - 8.3% of Americans Have Asthma | ACAAI Patient. Accessed June 25, 2025. https://acaai.org/asthma/asthma-101/facts-stats/
12. Nurmagambetov T, Kuwahara R, Garbe P. The economic burden of asthma in the United States, 2008-2013. Ann Am Thorac Soc. 2018;15(3):348-356. doi:10.1513/ANNALSATS.201703-259OC
13. Link J, Green H, Kaplan B, Collins P, Welch P, Johnson C. Medicaid Coverage of Guidelines-Based Asthma Care Across 50 States, the District of Columbia, and Puerto Rico, 2021–2022. Prev Chronic Dis. 2023;20:E79. doi:10.5888/PCD20.230022
14. Pruitt K, Yu A, Kaplan BM, Hsu J, Collins P. Medicaid Coverage of Guidelines-Based Asthma Care Across 50 States, the District of Columbia, and Puerto Rico, 2016-2017. Prev Chronic Dis. 2019;15(9). doi:10.5888/PCD15.180116
15. The Unequal Burden of Asthma on the Black Community | American Lung Association. Accessed June 25, 2025. https://www.lung.org/blog/asthma-burden-on-black-community
16. Baptist AP, Apter AJ, Gergen PJ, Jones BL. Reducing health disparities in asthma: how can progress be made. J Allergy Clin Immunol Pract. 2023;11(3):737. doi:10.1016/J.JAIP.2022.12.044
17. Amirav I, Garcia G, Le BK, et al. SABAs as Reliever Medications in Asthma Management: Evidence-Based Science. Adv Ther. 2023;40(7):2927. doi:10.1007/S12325-023-02543-9
18. Zhang X, Ding R, Zhang Z, Chen M, Yin Y, Quint JK. Medication Adherence in People with Asthma: A Qualitative Systematic Review of Patient and Health Professional Perspectives. J Asthma Allergy. 2023;16:515. doi:10.2147/JAA.S407552
19. Engelkes M, Janssens HM, De Jongste JC, Sturkenboom MCJM, Verhamme KMC. Medication adherence and the risk of severe asthma exacerbations: a systematic review. European Respiratory Journal. 2015;45(2):396-407. doi:10.1183/09031936.00075614
20. Makhinova T, Barner JC, Richards KM, Rascati KL. Asthma controller medication adherence, risk of exacerbation, and use of rescue agents among Texas medicaid patients with persistent asthma. Journal of Managed Care Pharmacy. 2015;21(12):1124-1132. doi:10.18553/JMCP.2015.21.12.1124/ASSET/IMAGES/LARGE/1126FIG.JPEG
21. Finkelstein JA, Barton MB, Donahue JG, Algatt-Bergstrom P, Markson LE, Platt R. Comparing asthma care for Medicaid and non-Medicaid children in a health maintenance organization. Arch Pediatr Adolesc Med. 2000;154(6):563-568. doi:10.1001/ARCHPEDI.154.6.563,
22. Pollack M, Gandhi H, Tkacz J, Lanz M, Lugogo N, Gilbert I. The use of short-acting bronchodilators and cost burden of asthma across Global Initiative for Asthma-based severity levels: Insights from a large US commercial and managed Medicaid population. J Manag Care Spec Pharm. 2022;28(8):881-891. doi:10.18553/JMCP.2022.21498/ASSET/IMAGES/FIG2.JPG
23. Hardy J, Baggott C, Fingleton J, et al. Budesonide-formoterol reliever therapy versus maintenance budesonide plus terbutaline reliever therapy in adults with mild to moderate asthma (PRACTICAL): a 52-week, open-label, multicentre, superiority, randomised controlled trial. The Lancet. 2019;394(10202):919-928. doi:10.1016/S0140-6736(19)31948-8
24. Sobieraj DM, Weeda ER, Nguyen E, et al. Association of inhaled corticosteroids and long-acting β-agonists as controller and quick relief therapy with exacerbations and symptom control in persistent asthma a systematic review and meta-analysis. JAMA - Journal of the American Medical Association. 2018;319(14):1485-1496. doi:10.1001/JAMA.2018.2769,
25. SMART Therapy for Asthma. Accessed June 25, 2025. https://www.aaaai.org/tools-for-the-public/conditions-library/asthma/smart
26. Reddel HK, Bateman ED, Schatz M, Krishnan JA, Cloutier MM. A Practical Guide to Implementing SMART in Asthma Management. Journal of Allergy and Clinical Immunology: In Practice. 2022;10(1):S31-S38. doi:10.1016/j.jaip.2021.10.011
27. Zaeh SE, Zimmerman ZE, Eakin MN, Chupp G. Adoption and implementation of maintenance and reliever therapy for adults with moderate-to-severe asthma. Annals of Allergy, Asthma and Immunology. 2024;133(3):318-324. doi:10.1016/J.ANAI.2024.06.011,
28. Krings JG, Gerald JK, Blake K V., et al. A Call for the United States to Accelerate the Implementation of Reliever Combination Inhaled Corticosteroid-Formoterol Inhalers in Asthma. Am J Respir Crit Care Med. 2023;207(4):390-405. doi:10.1164/RCCM.202209-1729PP/SUPPL_FILE/DISCLOSURES.PDF
29. Asthma Care Coverage | American Lung Association. Accessed June 25, 2025. https://www.lung.org/policy-advocacy/healthcare-lung-disease/asthma-policy/asthma-care-coverage/database
30. Pham T, Barker A, Eisenstein S, et al. A Comparative Cost Analysis of Maintenance and Reliever Therapy (MART) Versus Traditional Inhaler Therapy for Patients With Moderate-to-Severe Asthma From a United States Healthcare Payor Perspective. https://doi.org/101164/ajrccm2025211AbstractsA5253. 2025;211(Abstracts):A5253-A5253. doi:10.1164/AJRCCM.2025.211.ABSTRACTS.A5253
31. Nurmagambetov T, Kuwahara R, Garbe P. The economic burden of asthma in the United States, 2008-2013. Ann Am Thorac Soc. 2018;15(3):348-356. doi:10.1513/ANNALSATS.201703-259OC,
32. Lung Association A. Single Maintenance and Reliever Therapy (SMART) Implementation in State Medicaid Programs.
33. Campbell JD, Allen-Ramey F, Sajjan SG, Maiese EM, Sullivan SD. Increasing pharmaceutical copayments: impact on asthma medication utilization and outcomes. Am J Manag Care. 2011;17(10):703-710. Accessed June 29, 2025. https://pubmed.ncbi.nlm.nih.gov/22106463/
33. Sinaiko AD, Gaye M, Wu AC, et al. Out-of-Pocket Spending for Asthma-Related Care Among Commercially Insured Patients, 2004-2016. J Allergy Clin Immunol Pract. 2021;9(12):4324-4331.e7. doi:10.1016/J.JAIP.2021.07.054
References
-47-year-old St. Louis resident with asthma who tried MART
"I like the combined approach [MART therapy] better because I forget to take my [everyday inhaler] so much. And I don't forget to take my rescue inhaler because my body tells me when I need it."