OBJECTIVES: The burden of chronic obstructive pulmonary disease (COPD) and asthma could be reduced through appropriate medication therapy management. This study examines the relative propensity of Maryland Medicaid managed care organization (MMMCO) patients with COPD and asthma or either alone, to be prescribed fluticasone/salmeterol combination (FSC) METHODS: All medical and prescription claims for MMMCO enrollees with a diagnosis of COPD (ICD-9 codes 491, 492, 496) and/or asthma (ICD-9 codes 493) in the primary, or secondary diagnosis field, were retrieved. Study patients were 40 and older, claiming at least one FSC or other COPD drug with a minimum 30 days supply. The propensity of being prescribed FSC was estimated as a logistic function of patient age, gender, race, general health (as measured by the Charlson Comorbidity Index), and diagnosis of COPD and/or asthma. RESULTS: Out of total 9131 patients, half were African-American, 70% were female and over half were over 50 years old. After adjusting for confounders, patients with COPD and asthma were twice as likely to use FSC than those with Asthma along (OR 1.99, 95% CI 1.73-2.29); patients with COPD alone were 66% less likely to receive FSC than those with Asthma along (OR 0.34, 95% CI 0.28-0.41). African-Americans were a third less likely to be prescribed FSC than Caucasians (OR 0.69; 95% CI 0.61-0.78), and females about a third more likely than males to use FSC (OR 1.35; 95% CI 1.16-1.57). Age was not a significant predictor at the .05 level. CONCLUSION: The propensity to be prescribed FSC is significantly higher in patients with COPD/asthma than those with either disease alone. Race and gender significantly affect access to FSC in MMMCO, even after adjusting for comorbidities. Cost to the patient was not a factor, as the copayment was $1 for any prescription.