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Association Between Switching to a High-Deductible Health Plan and Discontinuation of Type 2 Diabetes Treatment.
JAMA Netw Open. 2019 11 01; 2(11):e1914372.JN

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.

Authors+Show Affiliations

Center for Value-Based Insurance Design, University of Michigan, Ann Arbor.Center for Value-Based Insurance Design, University of Michigan, Ann Arbor.Merck Research Laboratories, Merck & Co, Inc, Kenilworth, New Jersey.IBM Watson Health, Cambridge, Massachusetts.IBM Watson Health, Cambridge, Massachusetts.Merck Research Laboratories, Merck & Co, Inc, Kenilworth, New Jersey.Department of Health, Harvard Medical School, Boston, Massachusetts.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31675081

Citation

Fendrick, A Mark, et al. "Association Between Switching to a High-Deductible Health Plan and Discontinuation of Type 2 Diabetes Treatment." JAMA Network Open, vol. 2, no. 11, 2019, pp. e1914372.
Fendrick AM, Buxbaum JD, Tang Y, et al. Association Between Switching to a High-Deductible Health Plan and Discontinuation of Type 2 Diabetes Treatment. JAMA Netw Open. 2019;2(11):e1914372.
Fendrick, A. M., Buxbaum, J. D., Tang, Y., Vlahiotis, A., McMorrow, D., Rajpathak, S., & Chernew, M. E. (2019). Association Between Switching to a High-Deductible Health Plan and Discontinuation of Type 2 Diabetes Treatment. JAMA Network Open, 2(11), e1914372. https://doi.org/10.1001/jamanetworkopen.2019.14372
Fendrick AM, et al. Association Between Switching to a High-Deductible Health Plan and Discontinuation of Type 2 Diabetes Treatment. JAMA Netw Open. 2019 11 1;2(11):e1914372. PubMed PMID: 31675081.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association Between Switching to a High-Deductible Health Plan and Discontinuation of Type 2 Diabetes Treatment. AU - Fendrick,A Mark, AU - Buxbaum,Jason D, AU - Tang,Yuexin, AU - Vlahiotis,Anna, AU - McMorrow,Donna, AU - Rajpathak,Swapnil, AU - Chernew,Michael E, Y1 - 2019/11/01/ PY - 2019/11/2/entrez PY - 2019/11/2/pubmed PY - 2019/11/2/medline SP - e1914372 EP - e1914372 JF - JAMA network open JO - JAMA Netw Open VL - 2 IS - 11 N2 - 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. SN - 2574-3805 UR - https://www.unboundmedicine.com/medline/citation/31675081/Association_Between_Switching_to_a_High-Deductible_Health_Plan_and_Discontinuation_of_Type_2_Diabetes_Treatment L2 - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2019.14372 DB - PRIME DP - Unbound Medicine ER -