1-in-5 Patients with Diabetes Enrolled in High Deductible Plans Skip Refills, Forgo Medications Due to Cost

Vikas Gampa, MD

New research from the Cambridge Health Alliance and Massachusetts General Hospital paints a grim picture related to the cost of diabetes medications for some patients.

An analysis of healthcare costs using federal survey data from more than 7000 commercially insured patients, results suggest 1-in-5 patients with diabetes enrolled in a high-deductible health plan reported forgoing medications due to cost, which was 28% greater than the rate among patients with a traditional plan. Results also indicated this disparity grew even larger when examining trends among patients using insulin, with data indicating a 31% greater rate of missing medications due to cost for patients with a high-deductible health plan.

“Taking prescribed medications is essential for maintaining good health for patients with diabetes,” said Vikas Gampa, MD, a primary care doctor and instructor in medicine at Harvard Medical School, now at the Massachusetts General Hospital, in a statement. “Our results show that high-deductible health plans, particularly in this period of escalating prices for diabetes medication, are discouraging patients from getting the medications they need and thus they are placing patients with diabetes at risk.”

To develop a greater understanding of how healthcare costs impact patients. With diabetes, Gampa and a team of colleagues designed the current study as an analysis of data from within the National Health Interview Survey from 2011-2018. A cross-sectional household survey of a nationally representative sample of the US population, the survey provided investigators with information related to more than 35,000 US families. Excluding those not between 18-64 years of age, those without diabetes, and those without private insurance, investigators had identified a cohort of 7469 adult patients for inclusion in the study.

Participants were categorized based on enrollment in a high deductible health plan or a traditional commercial health plan. For the purpose of analysis, a high deductible health plan was one with an annual individual deductible of $1300 per year or a family deductible of $2400 per year from 2011-2014 and $2600 per year or more from 2015-2018.

Cost-related medication non-adherence was assessed through a series of questions, which inquired about each participant's ability to afford medications, instances of skipping medication doses to save money, taking less medicine to save money, or delaying a prescription for a medication to save money. Of note, investigators’ analyses were adjusted for multiple demographic and clinical characteristics through use of multivariable lines regression models.

Overall, 4478 patients reported enrollment in a traditional commercial health plan and 2691 reported enrollment in a high deductible health plan. Compared to those with a traditional plan, those with high deductible health plans were more likely to identify as White (69.7% vs 62.9%; P <.01), be employed (83.0% vs 79.3%; P <.01), have a college education (21.3% vs 18.2%; P <.01), and report a functional limitation (53.5% vs 49.9%; P <.05).

Upon analysis, results indicated patients enrolled in a high deductible health plan were more likely than their counterparts enrolled in a traditional commercial health plan to not fill a prescription ([13.4% vs 9.9%] AD, 3.4; 95% CI, 1.5-5.4), skip medication doses ([11.4% vs 8.5%] AD, 2.8; 95% CI, 1.0-4.7), take less medication ([11.1% vs 8.8%] AD, 2.3; 95% CI, 0.5-4.0) delay filling a prescription to save money ([14.0% vs 10.8%], AD, 3.0; 95% CVI, 1.1-4.9), and to have any form of cost-related medication non-adherence ([20.4% vs 15.5%] AD, 4.4 95% CI, 2.2-6.7). When assessing these associations in a subgroup of insulin users, results suggested insulin users enrolled in a high deductible health plan were more likely to report any cost-related medication non-adherence than their counterparts enrolled in a traditional commercial health plan ([25.1% vs 18.9%] AD, 5.9; 95% CI, 1.1-10.8).

Further analysis suggested patients reporting any cost-related medication non-adherence were more likely to have 1 or more emergency department visits but not hospitalizations. Similarly, insulin users reporting any cost-related medication non-adherence were more likely to have 1 or more emergency department visits ([43.7% vs 24.6%] AD, 11.2; 95% CI, 4.4-18.1) but not hospitalizations.

“Putting up financial barriers to care in order to save plans money—as high-deductible plans do—not only takes a medical toll on patients, it is also short-sighted because doing so actually increases other health care costs such as covering emergency department visits,” added Gampa.

This study, “Association Between High Deductible Health Plans and Cost-Related Non-adherence to Medications Among Americans with Diabetes: an Observational Study,” was published in the Journal of General Internal Medicine.