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Disclosure:
Galbraith reports that she has received grants from the Agency for Healthcare Research and Quality, Harvard Pilgrim Health Care, and the Patient-Centered Outcomes Research Institute. Please refer to the study for all relevant financial information from the other authors.
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The transition to a high-deductible health plan that largely exempted medication from the deductible was associated with minimal or no change in asthma controller use and exacerbations in children and adults with persistent asthma.
“Evidence for high-deductible health plans comes mainly from studies that focus on adults, and whether these findings apply to children is unclear,” said Alison A. Galbraith, MD, MPH, associate professor in the Department of Population Medicine at Harvard Pilgrim Health Care Institute at Harvard Medical School, and colleagues wrote in JAMA Pediatrics. “Some studies suggest that children are protected from cost cuts, while others have found that both children and adults are at risk.”
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The longitudinal cohort study used 2002-2014 data from a large national commercial administrative damage database. The researchers identified children and adults with persistent asthma who switched from traditional health insurance to high-deductible health insurance, most of which exempted asthma medication from the deductible, or who, at the employer’s option, continued with traditional plans for at least 24 months.
The high deductible health insurance group comprised 7,275 children (mean age 10.8 years; 60.5% boys) and 17,614 adults (mean age 41.1 years; 59.4% women), to whom 45,549 children and 114,141 adults were assigned as the control group.
The primary endpoint was 30-day fill rate and medication adherence to asthma controller drugs, which included inhaled corticosteroids (ICS), leukotriene inhibitors, and ICS long-acting beta agonists. Secondary endpoints were asthma exacerbation rates and asthma-related ED visits.
The researchers reported significant decreases in annual 30-day replenishment rates for ICS-LABA drugs in children who switched to high-deductible health plans compared to controls (absolute change, -0.04; 95% CI, – 0.07 to -0.01). However, there were no significant reductions in 30-day asthma controller drug fill rates in adults who switched to high-deductible health plans.
In addition, the researchers reported a significant decrease in the proportion of days covered for ICS-LABA controller medication among the 9.9% of participating high-deductible health plans eligible for a health insurance account that took high-deductible medication The researchers wrote that the deductible was discontinued compared to the control group compared (–4.8%; 95% CI, –7.7 to –1.9).
There were no significant differences in the proportion of days covered, oral steroid breakouts, or asthma-related ED visits for children or adults in this study.
“As the prevalence of high-deductible health plans continues to grow, these results suggest that participating in high-deductible health plans may not have negative outcomes in some situations, such as when medication is exempt from deductible or in patients with low deductible Basic use of asthma controllers, ”the researchers write. “These results suggest value-based designs as an approach for policymakers, payers and families to balance affordable coverage with access to essential asthma care.”
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