Reduced Cost-sharing for Preventive Drugs Preferentially Benefits Low-income Patients With Diabetes in High Deductible Health Plans With Health Savings Accounts

Abstract

Background:High deductible health plans linked to Health Savings Accounts (HSA-HDHPs) must include all care under the deductible except for select preventive services. Some employers and insurers have adopted Preventive Drug Lists (PDLs) that exempt specific classes of medications from deductibles.Objective:The objective of this study was to examine the association between shifts to PDL coverage and medication utilization among patients with diabetes in HSA-HDHPs.Research Design:A natural experiment comparing pre-post changes in monthly and annual outcomes in matched study groups.Subjects:The intervention group included 1744 commercially-insured HSA-HDHP patients with diabetes age 12–64 years switched by employers to PDL coverage; the control group included 3349 propensity-matched HSA-HDHP patients whose employers offered no PDL.Measures:Outcomes were out-of-pocket (OOP) costs for medications and the number of pharmacy fills converted to 30-day equivalents.Results:Transition to the PDL was associated with a relative pre-post decrease of $612 (−35%,P<0.001) per member OOP medication expenditures; OOP reductions were higher for key classes of antidiabetic and cardiovascular medicines listed on the PDL; the policy did not affect unlisted classes. The PDL group experienced relative increases in medication use of 6.0 30-day fills per person during the year (+11.2%,P<0.001); the increase was more than twice as large for lower-income (+6.6 fills, +12.6%,P<0.001) than higher-income (+3.0 fills, +5.1%,P=0.024) patients.Conclusion:Transition to a PDL which covers important classes of medication to manage diabetes and cardiovascular conditions is associated with substantial annual OOP cost savings for patients with diabetes and increased utilization of important classes of medications, especially for lower-income patients.

Effects of the Full Coverage Policy of Essential Medicines on Inequality in Medication Adherence: A Longitudinal Study in Taizhou, China

“…With increasing proportion of patients taking covered medicines year by year, the medication adherence of the general population improved. In other studies on FCPMs, low-income patients who converted from poor to high medication adherence contributed to an increase of 7.8% in medication adherence to statins [10] and increased twice more than the high-income patients with diabetes [5].…”

“…Among the countries, 54 had full coverage for essential medicines and 56 for chronic diseases [4]. FCPMs is also increasingly studied and implemented in hypertension and diabetes interventions in the United States [5,6], Canada [7], Brazil [8], Spain [9,10], Madagascar [11], India [12], and Burkina Faso [13].…”

Differential Cost-Sharing Undermines Treatment Adherence to Combination Therapy: Evidence from Diabetes Treatment

“…It is therefore important to find ways to improve the adherence among these patients by reducing the overall OOP cost burden and through disease education. Reduced cost-sharing for preventive drugs may benefit low-income patients with diabetes in high-deductible health plans with a health savings account [34].…”

Effects of the Full Coverage Policy of Essential Medicines on Inequality in Medication Adherence: A Longitudinal Study in Taizhou, China

“…Among these countries, 54 had full coverage programs for any essential medicines (Wang et al, 2019). FCPMs is also increasingly studied and implemented in hypertension and diabetes interventions in the United States (Zheng et al, 2017;Ross-Degnan et al, 2020), Canada (Laba et al, 2020), Brazil (Emmerick et al, 2020), Spain (Puig-Junoy et al, 2016;Gonzalez et al, 2017), Madagascar (Garchitorena et al, 2017), India (Bose and Dutta, 2018), and Burkina Faso (Yaogo, 2017).…”