No change in asthma medication use after transitioning to high-deductible health care plan
Source / Disclosures
Disclosures: 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 see the study for relevant financial information from all other authors.
The transition to a high-deductible health care plan that largely exempted drugs from the deductible was associated with little or no change in the use of asthma controllers and exacerbations in children and adults with dementia. persistent asthma.
“The evidence for high-deductible health plans comes mainly from studies focusing on adults and it is not clear whether these results can be applied to children.” Alison A. Galbraith, MD, MPH, associate professor at the department of population medicine Harvard Pilgrim Health Care Institute at Harvard Medical School, and colleagues wrote in JAMA Pediatrics. “Some studies suggest that children are protected from cutbacks in care because of cost, while others have found that children and adults are vulnerable.”
The longitudinal cohort study used 2002-2014 data from a large national commercial administrative complaints database. Researchers identified children and adults with persistent asthma who switched from traditional health care plans to high-deductible health plans, most of which exempt asthma drugs from the deductible, or continued to follow traditional plans by choice of the employer for at least 24 months.
The high-deductible health care 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 adherence for asthma control drugs, which included inhaled corticosteroids (ICS), leukotriene inhibitors, and long-acting beta-agonists. CSI action. Secondary outcomes included asthma exacerbation rates and asthma-related emergency room visits.
Researchers reported significant decreases in annual 30-day fill rates for ICS-LABA drugs in children who switched to high-deductible health plans compared to the control group (absolute change, -0.04; CI at 95%, -0.07 to -0.01). However, there was no significant reduction in 30-day fill rates for asthma control drugs 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 drugs among the 9.9% of those enrolled in a high-deductible health plan with high-deductible health plans eligible for the. health savings accounts that deductible drugs compared to 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 flushes or emergency room visits related to asthma for children or adults in this study.
“As the prevalence of high-deductible health insurance plans continues to increase, these results suggest that enrollment in a high-deductible health insurance plan may not be associated with negative outcomes in some situations. , for example, when drugs are exempt from the deductible or for those with a low deductible. basic use of the asthma controller, ”the researchers wrote. “These results suggest value-based designs as an approach for policy makers, payers and families in the quest for a balance between affordable coverage and access to needed asthma care.”