Address correspondence to Sheila K. Reiss, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA 02215; e-mail: firstname.lastname@example.org. Sheila K. Reiss, M.S., R.Ph., Dennis Ross-Degnan, Sc.D., Stephen B. Soumerai, Sc.D., and Alan M. Zaslavsky, Ph.D., are with the Harvard University Ph.D. Program in Health Policy, Cambridge, MA. Dennis Ross-Degnan, Fang Zhang, Ph.D., Stephen B. Soumerai, and J. Frank Wharam, M.B., B.Ch., B.A.O., M.P.H., are with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Alan M. Zaslavsky is with the Department of Health Care Policy, Harvard Medical School, Boston, MA.
Effect of Switching to a High-Deductible Health Plan on Use of Chronic Medications
Article first published online: 17 MAR 2011
© Health Research and Educational Trust
Health Services Research
Volume 46, Issue 5, pages 1382–1401, October 2011
How to Cite
Reiss, S. K., Ross-Degnan, D., Zhang, F., Soumerai, S. B., Zaslavsky, A. M. and Wharam, J. F. (2011), Effect of Switching to a High-Deductible Health Plan on Use of Chronic Medications. Health Services Research, 46: 1382–1401. doi: 10.1111/j.1475-6773.2011.01252.x
- Issue published online: 6 SEP 2011
- Article first published online: 17 MAR 2011
- High-deductible health plans;
- pharmaceutical use;
- chronic disease;
- differential cost-sharing
Objective. To examine whether high-deductible health plans (HDHPs) that exempt prescription drugs from full cost sharing preserve medication use for major chronic illness, compared with traditional HMOs with similar drug cost sharing.
Data Sources/Study Setting. We examined 2001–2008 pharmacy claims data of 3,348 continuously enrolled adults in a Massachusetts health plan for 9 months before and 24 months after an employer-mandated switch from a traditional HMO plan to a HDHP, compared with 20,534 contemporaneous matched HMO members. Both study groups faced similar three-tiered drug copayments. We calculated daily medication availability for all prescription drugs and four chronic medication classes: hypoglycemics, lipid-lowering agents, antihypertensives, and chronic obstructive pulmonary disease (COPD)/asthma controllers.
Study Design. Interrupted time-series with comparison group study design examining monthly level and trend changes in prescription drug utilization.
Principal Findings. The HDHP and control groups had comparable changes in the level and trend of all drugs after the index date; we detected similar patterns in the use of lipid-lowering agents, antihypertensives, and COPD/asthma controllers. Some evidence suggested a small relative decline in hypoglycemic use among diabetic patients in HDHPs.
Conclusions. Switching to an HDHP that included modest drug copayments did not change medication availability or reduce use of essential medications for three common chronic illnesses.