The Formulary Files

Drug utilization stable after switch to HDHP

Employers typically want to offer the most cost-effective health benefit package, even if employees feel more of a financial pinch. There has been concern that generalized cost sharing increases under high-deductible health plans (HDHPs) could have some undesirable effects, such as reducing use of medications that are excluded from the deductible.

But a new study from Health Services Research suggests that when employees switched from an HMO to an HDHP that included modest drug copayments, there was minimal change in medication availability or minimal reduction in the use of essential medications for diabetes, hypertension, COPD, and asthma. The researchers wrote, “Drug utilization is largely sustained following a switch to HDHP coverage when enrollees receive standard tiered copayment pharmacy benefit packages.”

The researchers examined data from claims for more than 3,300 adults enrolled at Harvard Pilgrim Health Plan for 9 months before and 24 months after an employer switched them from an HMO to an HDHP. This group was compared with 20,534 matched HMO members. The groups had similar three-tiered drug copayments.

Overall, both groups demonstrated a gradual increase in mean daily medications available (DMA) over the three study years, with the average level of medication use slightly lower in the HDHP group. Overall prescription spending for both groups showed comparably increasing rates.

Use of all prescription drugs in entire study cohort

Source: Reiss SK, Ross-Degnan D, Zhang F, Soumerai SB, Zaslavsky AM, Wharam JF. Effect of switching to a high-deductible health plan on use of chronic medications. Health Serv Res. 2011 Oct;46(5):1382-401. Permission to reproduce charts has been granted by the publisher.

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