Pre-deductible coverage in health savings plans improves medication adherence

Pre-deductible coverage boosts adherence: ©Sherry Young - stock.adobe.com

A report published by the Employee Benefit Research Institute found that expanding pre-deductible coverage in health savings account (HSA)-eligible health plans led to an increase in medication adherence, particularly among individuals managing chronic conditions like diabetes and heart disease.

The report analyzed the effects of IRS Notice 2019-45, which allows HSA-eligible plans to cover 14 drug classes and other preventive health services before the plan deductible is met. The research utilized claims data from 2022 to assess the impact of this expanded coverage.

Key Findings:

Increase in medication adherence: By 2022, there was a noticeable rebound in medication adherence. Specifically, the percentage of enrollees with diabetes using insulin rose by 4 percentage points, while those using statins for heart disease or diabetes saw a 1 percentage point increase. Although these changes may seem modest, they reflect the relatively small declines observed when HSA-eligible plans were first introduced, according to the report.

High baseline adherence rates: The study found that overall adherence rates were already relatively high, ranging from 77% to 89%, which may have limited the potential for large increases.

Employer adoption of pre-deductible coverage: The response from employers was significant, with three-quarters of them expanding pre-deductible coverage for at least one of the 14 drug classes. Diabetes medications and beta blockers saw the most significant coverage expansion, with 66% and 54% of employers adding pre-deductible coverage, respectively. However, less than half of the employers extended this coverage to the remaining drug classes.

Paul Fronstin, Ph.D., co-author of the report and director of Health Benefits Research at EBRI, said: “Our analysis confirms that medication adherence improved among enrollees using statins and insulin. Adherence may have improved even more if the majority of employers had eliminated cost-sharing completely, instead of substituting copayments or coinsurance for deductibles.” He also noted that lack of awareness among enrollees about plan design changes may have hindered greater improvements in adherence.

The research was conducted through the EBRI Center for Research on Health Benefits Innovation, with funding support from Aon, Blue Cross Blue Shield Association, Johnson & Johnson, JPMorgan Chase & Co, and the Pharmaceutical Research and Manufacturers of America.