No change in asthma medication use after transition to high-deductible health plan

Transition to a high-deductible health plan that largely exempted medications from the deductible was associated with minimal or no change in use of asthma controllers and exacerbations among children and adults with persistent asthma.

“Evidence about high-deductible health plans comes mostly from adult-focused studies and whether these findings can be applied to children is unclear,” 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 reductions in care due to cost, whereas others have found that both children and adults are vulnerable.”

The longitudinal cohort study used 2002-2014 data from a large national, commercial administrative claims database. The researchers identified children and adults with persistent asthma who switched from traditional health care plans to high-deductible health plans, of which most exempted asthma medications from the deductible, or continued with traditional plans by employer choice for at least 24 months.

The high-deductible health plan group included 7,275 children (mean age, 10.8 years; 60.5% boys) and 17,614 adults (mean age, 41.1 years; 59.4% women) who were matched with 45,549 children and 114,141 adults who served as a control group.

The primary outcome was 30-day fill rates and medication adherence for asthma controller medications, which included inhaled corticosteroids (ICS), leukotriene inhibitors and ICS-long-acting beta agonists. Secondary outcomes included asthma exacerbation rates and asthma-related ED visits.

The researchers reported significant decreases in annual 30-day fill rates for ICS-LABA medications in children who switched to high-deductible health plans compared with the control group (absolute change, –0.04; 95% CI, –0.07 to –0.01). However, there were no significant reductions in 30-day fill rates for any asthma controller medications in adults who switched to high-deductible health plans.

In addition, the researchers reported a significant decrease in proportion of days covered for ICS-LABA controller medications among the 9.9% of high-deductible health plan enrollees with health savings account-eligible high-deductible health plans that subjected medications to the deductible compared with the control group (–4.8%; 95% CI, –7.7 to –1.9), the researchers wrote.

There were no significant differences in the proportion of days covered, oral steroid bursts or asthma-related ED visits for children or adults in this study.

“As the prevalence of high-deductible health plans continues to increase, these findings suggest that high-deductible health plan enrollment may not be associated with negative outcomes in some situations, for example, when medications are exempt from the deductible or for those with low baseline asthma controller use,” the researchers wrote. “These findings suggest value-based designs as an approach for policymakers, payers and families in the quest for balance affordable coverage with access to necessary asthma care.”