Higher Deductibles Linked to Skipping Diabetes Medications

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Higher Deductibles Linked to Skipping Diabetes Medications

Higher deductibles in health insurance plans are linked to less adherence to taking diabetes medications as prescribed, according to a new study published in the Journal of General Internal Medicine.

In health insurance plans, the deductible is the amount of money patients must pay out-of-pocket before the plan covers certain health care expenses. Some plans have general deductibles that must be met before the plan covers any expenses (with certain exceptions), while others have separate deductibles for medications and for other health care services. In recent years, there has been a trend toward high-deductible health insurance plans in the United States, because these plans tend to carry lower monthly premiums. This is problematic for many people with diabetes, because diabetes medications can pose a significant financial burden before high-deductible plans start to pay for them.

For the latest study, researchers used data from repeated surveys that asked people to answer a wide range of questions about their health and use of the health care system. The included participants were 7,469 people ages 18 to 64 with private health insurance, who had diabetes and were prescribed diabetes medications. Each participant was enrolled in either a traditional commercial health plan or a high-deductible health plan.

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Those with high-deductible plans more likely to take cost-saving measures

As part of the surveys, participants were asked several questions about cost-related nonadherence to taking their diabetes medications as prescribed. Their responses were adjusted based on differences between the high-deductible and traditional insurance groups, such as demographic factors like age and clinical differences like whether they had other health conditions. Based on these responses, participants who were enrolled in high-deductible plans were more likely to not fill a prescription for a diabetes medication (13.4% versus 9.9%), to skip doses of a diabetes medication (11.4% versus 8.5%), to take less of a medication than prescribed (11.1% versus 8.8%), and to delay filling a prescription to save money (14.4% versus 10.8%) — as well as to answer “yes” to any of these practices (20.4% versus 15.5%). Among participants who took insulin, those enrolled in a high-deductible plan were also more likely to report engaging in at least one of these cost-saving practices for their insulin (25.1% versus 18.9%).

“Taking prescribed medications is essential for maintaining good health for patients with diabetes,” said study author Vikas Gampa, MD, MPH, a primary care doctor and instructor in medicine at Harvard Medical School, in a press release. “Our results show that high-deductible health plans, particularly in this period of escalating prices for diabetes medication, are discouraging patients from getting the medications they need and thus they are placing patients with diabetes at risk.”

The study also found that participants who skipped diabetes medications to save money were more likely to have one or more emergency room visits than those who didn’t skip their medications. This result shows that high-deductible plans, at least for people with diabetes, probably don’t even have their intended effect of saving the health insurer money, since emergency room visits tend to be expensive for both patients and health insurance providers — and represent a burden on the health care system as a whole, since many off these visits likely could have been avoided by taking diabetes medications as prescribed.

“Patients with diabetes should recognize that a high-deductible plan will put them at risk for missing or delaying their medications, and doctors need to recognize that their patients with these plans may not be able to adhere to treatment plans,” said study author Danny McCormick, MD, a primary care doctor and associate professor of medicine at Harvard Medical School, in the press release. “Ultimately, policymakers need to enact reforms that discourage health plans from implementing financial barriers that block access to needed care, such as high-deductible plans.”

Want to learn more about saving on your diabetes care? Read “Save Money on Medicines,” “How Your Healthcare Team Can Help You Save on Medications” and “Do’s and Don’t’s for Saving Money With Diabetes.” 

Quinn Phillips

Quinn Phillips

Quinn Phillips on social media

A freelance health writer and editor based in Wisconsin, Phillips has a degree from Harvard University. He is a former Editorial Assistant for Diabetes Self-Management and has years of experience covering diabetes and related health conditions. Phillips writes on a variety of topics, but is especially interested in the intersection of health and public policy.

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