Value-Based Care News

High-Deductible Health Plans Are a Big Hit to Medication Adherence

Patients in high-deductible health plans are facing higher costs for branded medications, causing an issue with medication adherence.

High-deductible health plans, Medication adherence

Source: Getty Images

By Samantha McGrail

- Patients with diabetes enrolled on a high-deductible health plan have a hard time paying for their brand-name medications, having a negative impact on medication adherence, according to new data published in JAMA Open Network.

In 2017, 28 percent of US adults with employer-sponsored insurance were enrolled in HDHPs, facing significantly expensive deductibles. High cost-sharing of this variety has been associated with financial stress, worse disease control, increases in hospitalizations, and exacerbation of health disparities, the study stated.  

Study authors specifically zeroed in on the impact on HDHP enrollment on medication adherence among diabetic patients. In a retrospective study, researchers looked at claims data from the MarketScan database to analyze medication adherence for 2,980 patients with diabetes, half of whom were enrolled in an HDHP and half of whom were not.

Researchers measured medication adherence by looking at how many patients enrolled on each plan type refilled an antihyperglycemic medication, a common drug used to manage diabetes.

On the whole, researchers observed little different in medication adherence — measured by a patient refilling their diabetes medications — for patients in HDHPs and non-HDHPs. However, when looking exclusively at patients on a brand-name drug, the researchers found some health disparities.

Twenty percent of all patients taking a branded diabetes medication on an HDHP had low medication adherence, compared to only 14 percent of those with poor adherence in a non-HDHP.

These findings could have impacts on future policymaking, particularly how it connects to drug pricing and patient access to health payer coverage, the study authors stated.

“The discontinuation of antihyperglycemic medications absent clinical justification is potentially dangerous,” the research team concluded. “The findings of the present study, especially when viewed in light of previous research, provide evidence to suggest that HDHP enrollment is a potential risk factor for discontinuation of branded medications. Payers, policy makers, and health care professionals can and should implement aligned incentives to ensure patients have access to clinically indicated care.”

For example, value-based insurance design (V-BID) could help connect more patients to affordable medications, thus improving medication adherence.

V-BID in type 2 diabetes treatment would call for plan designs that favor the use of low-cost generic medications when possible, the researchers said.

“A V-BID entails aligning patients’ out-of-pocket cost-sharing with the value of the underlying service-that is, lowering cost-sharing for high-value services and/or increasing cost-sharing for low value-services,” the team wrote.

In addition, study findings can also inform care management and referral to cost assistance programs. 

“Care improvement efforts of this sort should prioritize outreach to lower-income patients with type 2 diabetes because evidence suggests that the association between HDHP enrollment and access to high-value type 2 diabetes care varies across socioeconomic lines,” the researchers said.

Those with HDHPs are more likely to skip care because of the lack of affordability, according to a study from June of this year. Because of this, medication adherence is slowly becoming a problem. 

Specifically, 49 percent of patients in the highest deductible bracket said they have decided to do without medical care, compared to 40 percent in no-deductible plans who have done the same. 

According to the study, 19 percent of respondents said they have refused to fill a prescription because of the significantly high cost, while 12 percent cut their pills in half or skipped doses to preserve their medications.18 percent of respondents are turning to over-the-counter drugs. 

Patient’s inability to afford healthcare costs is causing rising concern for experts, according to new data from the Integrated Benefits Institution (IBI).  

About 25 percent of patients put off medical care, while about 20 percent decided they couldn’t afford care at all. And, about one-in-six patients could not afford their prescription medication, according to the data.

“We’re not surprised that a lot of people put off or did without medical care because they just couldn’t afford it,” said Brian Gifford, PhD, IBI’s research director, and the study’s lead author. “More and more studies show that even people who have jobs with health benefits cut back on necessary healthcare services due to the out-of-pocket costs of high deductibles, copayments, and coinsurance.”