HDHPs Do Not Affect Asthma Exacerbations, Medication Use for Children


Individuals who switched to high-deductible health plans had small decreases in annual 30-day fills for inhaled corticosteroid-long-acting beta agonists but not for other controller drugs.

Switching to a high-deductible health plan (HDHP) is not associated with changes in asthma exacerbations or asthma medication use when medications are exempted from the deductible, according to research results published in JAMA Pediatrics.

Clinical guidelines for pediatric asthma recommend the use of controller medications, though the investigators noted in a statement that adherence to these medications is generally suboptimal. Not taking medications as prescribed can lead to exacerbations, and high out-of-pocket costs have been associated with decreased controller medication use and adverse asthma outcomes.

Most research on HDHPs has focused on adult patients, according to the statement.

The new study, however, examined how enrollment in HDHPs may affect asthma controller medication use and exacerbations in children.

The study population included children ages 4 to 17 and adults ages 18 to 64 and was drawn from a commercial, large national database. Participants had persistent asthma and switched from traditional plans to HDHPs during a 24-month study period.

The investigators found that compared with those who remained in traditional plans, children who switched to HDHPs experienced small decreases in annual 30-day fills for inhaled corticosteroid-long-acting beta agonist medications but not for other controller medications.

Adults switching to HDHPs did not have significant reductions in 30-day fills for any asthma controller medications, according to the statement.

“One challenge of insurance design is balancing affordable coverage with access to necessary care for chronic conditions for both children and adults,” team leader Alison Galbraith, MD, MPH, associate professor in the Department of Population Medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute in Boston, said in the statement. “Our findings highlight the potential protective effect of exempting asthma medications from the deductible in high-deductible health plans.”

The investigators found no statistically significant differences in asthma-related emergency department visits, medication adherence, or oral steroid bursts for either adults or children.

Future areas of research could focus on the impact of value-based insurance designs on asthma control and medication adherence, Galbraith said.

“Asthma is a major cause of preventable disease burden for both children and adults,” she said. “Policy makers should consider adopting value-based designs and other policies exempting important medications for asthma and other chronic conditions—which might prevent adverse clinical outcomes—from the deductible.”


Asthma Medication Use and Exacerbations. Press Release. Harvard Pilgrim Health Care Institute; May 25, 2021. Accessed May 26, 2021. https://www.populationmedicine.org/press/GalbraithJAMAPeds0521

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