Prescription Drug Use in High-Deductible Plans

The impacts of the rapidly growing high-deductible health insurance design continue to be closely studied.  Concerns still exist that the higher cost may be deterring not only use of inappropriate care, but also of needed and beneficial care.  A recent study by the Employee Benefits Research Institute focused on prescription drug use by enrollees in a high-deductible plan with a health savings account.    (EBRI Article)   The study involved workers and dependents at one large company that implemented a full replacement high-deductible with health savings account plan.  Over 80% of the workers choose the higher deductible option, $2,150 per individual and $4300 at the family level.  Data from one year before and four years after implementation of this new plan were analyzed and compared to a control group.  In the year prior to the start of the new plan, the average patient had ten prescriptions a year, two-thirds filled with generics and over 70% were maintenance medications for chronic illnesses.

In the first year after implementation, the generic fill rate across all prescriptions  rose by 4.7% and it remained 3.4% higher after four years.  The generic fill rate was around this area for maintenance medications, but only 1.7% for non-maintenance meds.  In regard to certain chronic conditions, the generic fill rate rose 4.5% after four years for high blood pressure, 15.4% for high cholesterol drugs, 7.8% for asthma and COPD drugs, but declined over 8% for depression.  This appears good on the service, indicating a more cost-conscious purchase of drugs, but the increase in fill rates was accomplished not by a switch from brand drugs to generics, but by an overall lower number of prescriptions, with a bigger drop in brand fills than in generic fills.  And much of the decline was in maintenance drugs for chronic disease.   The concern obviously is whether consumers were foregoing needed medications due to cost.  And it simply isn’t possible to tell just from this analysis, but the decline in chronic illness fills is of concern.  It would be useful for the analysis to be able to compare prescriptions written with those filled, to see if fewer prescriptions are being written or if consumers are just not filling them.  And it would also be useful to have data to assess whether there was any change in health outcomes, particularly in regard to the chronic diseases for which prescriptions were not filled.