809-P: The Impact of High-Deductible Health Plans (HDHPS) and Out-of-Pocket (OOP) Costs on Access to Care in Diabetes

Abstract

Background: HDHP use and high OOP costs are associated with decreased healthcare resource use (HCRU) and access to care, among those with lower incomes, or racial and ethnic minorities. The potential impact on diabetes care is a public health concern, given that regular access to medications is critical to avoid severe complications. The objective of this study was to characterize the impact of HDHPs and high OOP costs on access to care and HCRU among Americans with diabetes, and the interaction of race/ethnicity and income. Methods: A systematic review was performed using Medline/EMBASE to identify records from the past 10 years, describing the impact of HDHPs, or high OOP costs or copayments, on access to care (e.g., not pursuing care because of cost) or HCRU (e.g., medication use, physician visits). The focus of the review was on Americans with diabetes; whether the impact of race/ethnicity and income was reported was also captured. Results: From 2707 abstracts, 2 described the impact of HDHPs among those with diabetes and 9, high OOP/copayment costs. Four studies (36.4%) reported the impact of race/ethnicity: Black and non-Hispanic patients with diabetes tended to be at higher risk of non-adherence than white patients. Three studies (27.2%) reported the impact of income: Lower-income patients with diabetes were at higher risk of non-adherence and decreased HCRU, versus higher-income patients. Only one study reported on both race/ethnicity and income, but not the interaction of these. Conclusions: These findings suggest that HDHP use and high OOP costs are associated with decreased HCRU and adherence among Americans with diabetes. This effect may be more pronounced among those of non-white race/ethnicity or with low income. Notably, no studies reported the impact of HDHPs and high OOP costs on access to care. Understanding how race/ethnicity and income interact will be important to fully recognize the impact of HDHPs and high OOP costs on outcomes among Americans with diabetes. Disclosure S. M. Szabo: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc. E. Kuti: Employee; Self; Boehringer Ingelheim Pharmaceuticals, Inc. M. Friesen: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc. D. Reardon: Employee; Self; Boehringer Ingelheim Pharmaceuticals, Inc. E. Jaykus: Employee; Self; Boehringer Ingelheim Pharmaceuticals, Inc. R. Corepal: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc. B. M. K. Donato: Employee; Self; Boehringer Ingelheim Pharmaceuticals, Inc. Funding Boehringer Ingelheim