Harvard University

Long-Term Impact of Reduced Patient Out-of-Pocket Costs on Diabetes Complications

High-deductible health plans that require patients to pay up to $1,000-$6,000 in out-of-pocket (OOP) costs per year are now the predominant private health insurance arrangement.  The increased OOP costs required by HDHPs are associated with delays in seeking care, increases in acute preventable diabetes complications, and increases in high-severity emergency department visits among low-income HDHP members. HDHPs associated with health savings accounts (HSA-HDHPs) usually subject antiglycemic medications to the full deductible, with the average HSA-HDHP member paying $700-$1,000 per year for insulin (REF). Preventive drug lists (PDLs) that reduce medication cost may prevent rationing and underuse of antiglycemic medications among low-income HDHP members. Using an interrupted time series design, this study will analyze data from a 16-year rolling cohort to determine whether employer switches from HSA-HDHPs to more generous low-deductible plans or the introduction of $0 PDLs to HSA-HDHPs are associated with a reduction of acute and chronic diabetes complications, including among low-income and high-morbidity members.