High Deductible Health Plans Associated With No Change in Asthma Care

Neither adherence to asthma controller medications nor asthma exacerbations appeared to change significantly when patients with asthma switched from traditional health plans to high-deductible health plans (HDHPs), according to a study published in JAMA Pediatrics.

“This cohort study found that in a population where medications were exempt from the deductible for most enrollees, HDHP enrollment was associated with minimal or no reductions in controller medication use for children and adults,” researchers wrote, “and no change in asthma exacerbations.”  

The longitudinal cohort study included 7275 children and 17,614 adults with persistent asthma who switched to a HDHP. In most, asthma medications were exempt from the deductible and subject to copayments, researchers explained. A matched control group included 45,549 children and 114,141 adults with persistent asthma who stayed in traditional plans. 

Children switched to HDHPs showed significant decreases (−0.04 absolute change) in annual 30-day fills for inhaled corticosteroid long-acting β-agonists (ICS-LABAs) but not for inhaled corticosteroid (ICS) or leukotriene inhibitors, the study showed, compared with children in the control group. Adults switched to HDHPs did not show significant reductions in 30-day fills for any of the asthma controller medications.  

The study found no statistically significant differences in controller medication adherence (which researchers measured by proportion of days covered) or asthma exacerbations (measured by rates of oral steroid bursts and asthma-related emergency department visits) for children or adults.

“These findings suggest a potential benefit from exempting asthma medications from the deductible in HDHPs,” researchers advised.

Reference: 

Galbraith AA, Ross-Degnan D, Zhang F, et al. Controller Medication Use and Exacerbations for Children and Adults With Asthma in High-Deductible Health Plans. JAMA Pediatr. 2021;175(8):807-816. doi:10.1001/jamapediatrics.2021.0747