Controller Medication Use and Exacerbations for Children and Adults With Asthma in High-Deductible Health Plans

Abstract

To examine the association between enrollment in high-deductible health plans (HDHPs) and asthma controller medication use and exacerbations.A longitudinal cohort of children (4–17 years old) and adults (18–64 years old) on employer-sponsored insurance, who had at least 24 months of continuous insurance enrollment.Identified from a national administrative claims database in the United States, patients with persistent asthma were selected, and their insurance was categorized as a HDHP, defined as an annual individual deductible of ≥$1000, or a traditional plan, with deductibles of $0–500. Enrollees in a HDHP were only those who switched from a traditional plan after 12 months to a HDHP for the following 12 months. A differences-in-differences analyses design was used to compare outcomes between patients who switched to a HDHP to that of controls, who remained in a traditional plan for the 24 months. Outcomes included controller medication fills, adherence, and asthma exacerbations.The study sample included 7275 children and 17 614 adults with HDHPs. In the differences-in-differences analyses among children, there were no differences in controller medical fill rates, except for a significant reduction in fills for inhaled corticosteroid (ICS) and long-acting beta-agonist (LABA) (−0.04; 95% confidence interval: −0.07 to −0.01). There were also no significant changes in the proportion of days covered by a controller medication (ie, adherence measure), steroid bursts, or asthma-related ED visits, comparing children with HDHPs to controls. Among adults with HDHPs, there were also no significant differences in outcomes.The findings are consistent with previous adult studies that revealed that enrollment in HDHPs have minimal to no decrease in medication use and without significant changes in health outcomes. The authors think this is partly due to HDHPs exempting medications, like asthma controller medications, from deductibles. These medications are instead paid in a copayment arrangement.This insurance policy approach reveals that HDHPs can be designed to support affordable coverage but also preserve necessary asthma care for patients.