Association Between Switching to a High-Deductible Health Plan and Discontinuation of Type 2 Diabetes Treatment.

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  • Additional Information
    • Source:
      Publisher: American Medical Association Country of Publication: United States NLM ID: 101729235 Publication Model: Electronic Cited Medium: Internet ISSN: 2574-3805 (Electronic) Linking ISSN: 25743805 NLM ISO Abbreviation: JAMA Netw Open Subsets: MEDLINE
    • Publication Information:
      Original Publication: Chicago, IL : American Medical Association, [2018]-
    • Subject Terms:
      Deductibles and Coinsurance* ; Health Benefit Plans, Employee*; Diabetes Mellitus, Type 2/*drug therapy ; Hypoglycemic Agents/*economics ; Medication Adherence/*statistics & numerical data; Cohort Studies ; Databases, Factual ; Diabetes Mellitus, Type 2/epidemiology ; Drug Prescriptions/statistics & numerical data ; Drugs, Generic ; Female ; Humans ; Hypoglycemic Agents/therapeutic use ; Male ; Matched-Pair Analysis ; Middle Aged ; Retrospective Studies ; United States/epidemiology
    • Abstract:
      Importance: High-deductible health plans (HDHPs) are a common cost-savings option for employers but may lead to underuse of necessary treatments because beneficiaries bear the full cost of health care, including medications, until a deductible is met.
      Objectives: To evaluate the association between switching from a non-HDHP to an HDHP and discontinuation of antihyperglycemic medication and to assess whether the association differs in patients using branded vs generic antihyperglycemic medications.
      Design, Setting, and Participants: This retrospective matched cohort study used administrative claims from MarketScan databases to identify commercially insured adult patients with type 2 diabetes who used at least 1 antihyperglycemic medication in 2013. Patients in the HDHP cohort (n = 1490) were matched by propensity scores to a non-HDPH control cohort (n = 1490). Data were collected and analyzed from January 1, 2013, through December 31, 2014.
      Exposures: Switching from a non-HDHP in 2013 to a full replacement HDHP in 2014 (no non-HDHP option offered) vs staying on a non-HDHP.
      Main Outcomes and Measures: Difference-in-differences models estimated discontinuation of branded and generic antihyperglycemic medications.
      Results: Among the 2980 patients included in the analysis (1932 men [64.8%]; mean [SD] age, HDHP cohort: 52.6 [6.9] years; non-HDHP cohort: 52.7 [7.3] years), no difference between the HDHP and non-HDHP cohorts was found in unadjusted follow-up discontinuation rates for all antihyperglycemic medications (255 [22.7%] vs 255 [23.3%]; P = .72); however, among patients using branded medication, a significantly greater proportion of patients in the HDHP group did not refill branded medications (81 of 396 [20.5%] vs 61 of 437 [14.0%]; P = .009). Difference-in-differences models were not statistically significant.
      Conclusions and Relevance: These findings suggest switching to an HDHP is associated with discontinuation specifically of branded medications. Unintended health consequences may result and should be considered by employers making health care benefit decisions.
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    • Accession Number:
      0 (Drugs, Generic)
      0 (Hypoglycemic Agents)
    • Publication Date:
      Date Created: 20191102 Date Completed: 20200615 Latest Revision: 20211120
    • Publication Date:
      20231215
    • Accession Number:
      PMC6826641
    • Accession Number:
      10.1001/jamanetworkopen.2019.14372
    • Accession Number:
      31675081