The Impact of Consumer-Directed Health Plans on Prescription Drug Use

Consumer-directed health plans (CDHPs) combine high-deductible insurance coverage with tax-exempt personal spending accounts, allowing enrollees to pay for their medical costs before reaching the deductible from either their own pocket or with money from the account.  The argument is that CDHP enrollees will comparison shop for their health care services and therefore reduce unnecessary use.  The authors chose to examine whether enrollees in CDHPs exhibit more cost-effective use of chronic-illness medications than do those with three-tier pharmacy coverage.  Selected drug classes were for conditions that are primarily symptomatic (antidepressant, asthma controllers, and anti-ulcerants) and asymptomatic (antihypertensives and lipid-lowering agents).

High-deductible CDHP enrollees were 2 to 3 times more likely than others to discontinue antihypertensives (17.4 percent vs. 5.6 percent) and lipid-lowering (16.6 percent vs. 6.2 percent) drugs, two silent but deadly chronic conditions.  Plan enrollment was not related to discontinuation for the drug classes treating primarily symptomatic chronic illnesses.  There was no difference in adherence rates across the different drug classes.  Only the use of generic antidepressants increased among all types of enrollees, though the increases among the high-deductible CDHP enrollees were significantly greater than among others.

 

Commentary:

The health savings accounts facet of the CDHPs are premised on not only the access of enrollees to medical information resources, but also their actual comprehension and application of that information to their own health conditions. Based on the findings from this single employer, the consumer-directed portion of these plan requires much more direction if they are to be successful.  Enrollees were only shown to continue treatment on those illnesses that are symptomatic.  

Patients with chronic illnesses, often asymptomatic before serious end-organ damage occurs, are dealing with complex entities that are not always best served by short-term interests (i.e. annual finances).  Therefore there must be additional, professional-based, assistance to these enrollees, rather than just the provision of web-based information.  Influence on patient behavior will need to involve a multi-disciplinary approach for all patients as we strive for greater autonomy within medical decision-making.

Health Affairs. 2008; 27 (4): 1111-1119.

 

by

Kameron L. Matthews, MD, Esq.

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