Effects of High Deductible Health Care Plans on Asthma Drug Use in Children

Enrollment in high-deductible health plans (HDHP) may not be associated with changes in asthma drug use or exacerbations when drugs are exempt from the deductible, according to findings from a longitudinal cohort study published in Pediatrics JAMA.

High-deductible health plans are increasingly common, and although they are associated with decreased drug use in some adult populations, their effect on children is less well known. Therefore, the researchers examined the association between enrollment in HDHP and the use of asthma control drugs and exacerbations in children aged 4 to 17 and adults aged 18 to 64 with with persistent asthma who switched from traditional plans to HDHP or remained in traditional plans (control group) as chosen by the employer for a period of 24 months.

The HDHP group consisted of 7,275 children and 17,614 adults and the matched control group consisted of 45,549 children and 114,141 adults. Asthma medications included inhaled corticosteroids (ICS), leukotriene inhibitors, and long-acting ICS β-agonists (ICS-LABA). Compared to control individuals, children switching to HDHP experienced significant absolute decreases (absolute change, -0.04; 95% CI, -0.07 to -0.01) in annual 30-day refills for ICS-BALA only. The changes in fill rates for the other control drugs were not statistically significant after adjusting for multiple comparisons.

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Adults switching to HDHP did not have a significant reduction in the number of 30-day prescription refills for any of the controllers. There were no statistically significant differences in the proportion of days covered (PDC), oral steroid surges or emergency room visits related to asthma in children or adults. For the 9.9% of those enrolled in HDHP with HDHP eligible for the health savings account who submitted drugs to the deductible, there was a significant absolute decrease (change, -4.8%; 95% CI , -7.7% to -1.9%) of PDC for ICS -LABA compared to control individuals.

“This cohort study found that in a population where drugs were exempt from the deductible for most registrants, enrollment in HDHP was associated with minimal or no reduction in controller drug use for children and adults and no change in asthma exacerbations, ”the authors concluded. “These results suggest a potential benefit in exempting asthma drugs from the deductible in HDHP.”

Disclosure: One study author reported affiliations with biotechnology, pharmaceutical, and / or device companies. Please see the original reference for a full list of author disclosures.


Galbraith AA, Ross-Degnan D, Zhang F et al. Controlling drug use and exacerbations in children and adults with asthma in high-deductible health plans. JAMA Pediatr. Published online May 10, 2021. doi: 10.1001 / jamapediatrics.2021.0747

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