Financial Burdens of Out-of-Pocket Prescription Drug Expenditures under High-Deductible Health Plans
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J Gen Intern Med DOI: 10.1007/s11606-020-06226-x © Society of General Internal Medicine (This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply) 2020
INTRODUCTION
The costs of prescription drugs increased significantly in the USA over the past few years.1 The prevalence of high-deductible health plans (HDHPs) also increased steadily over the last two decades.2 Since HDHP enrollees may face the full cost of their initial purchases of prescription drugs, increases in the prices of prescription drugs are likely to have a significant impact on HDHP enrollees. Prior research examined total out-of-pocket health care expenditure burdens of HDHP enrollees.3, 4 Little is known, however, about the burdens of out-of-pocket prescription drug expenditures in particular. This study examines financial burdens of out-of-pocket prescription drug expenditures across different levels of deductibles. The study focuses on low-income adults (family income less than 250% of Federal Poverty Level) with multiple, prevalent chronic conditions, who are more likely to be constrained by their resources and use more prescription drugs.
categories—high-deductible (deductible levels exceeded the Internal Revenue Service threshold for high-deductible plans), low-deductible (deductibles were below the Internal Revenue Service threshold), and no-deductible health plans. Two-tailed t tests were used for making comparisons.
RESULTS
Among all adults (n = 39,421), the prevalence of 10-percent prescription drug burden was 1.2% or lower for any deductible group (Table 1). Among low-income adults (n = 7,510), the prevalence of 10-percent burden for high- and low-deductible enrollees was 5.0% (p < .01) and 3.1% (p < .01), respectively, compared with 1.6% among no-deductible enrollees. Among low-income adults with two or more chronic conditions (n = 1,354), the high burden rate for the high-deductible group, at 14.3%, was higher than that for the no-deductible group at 5.5% (p < .05). Among low-income adults with multiple chronic conditions, high-deductible enrollees were more likely than the no-deductible enrollees to have a 10-percent burden from brand name drugs alone (11.5% versus 3.2%, p < .05), but the differences in the prevalence of 10-percent burden from generic drugs alone across deductible groups were not statistically significant (Table 2).
METHODS
Data for this analysis come from 2012–2017 Medical Expenditure Panel Survey Household Component (MEPS-HC). The sample was restricted to adults ages 19 to 64 who were enrolled in employer-sponsored health insurance plans throughout the year. Data was pooled across multiple years given the small sample size of the subpopulation of lowincome adults with multiple chronic conditions. The following self-reported chronic conditions were identified: Diabetes, asthma, hypertension, arthritis, heart disease, cancer, chronic bronchitis, stroke, and emphysema. Following the literature, financial burden of prescription drugs was calculated as ann
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