Department of Population Medicine, Division of Health Policy and Insurance Research, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu, Zhang, Madden, Callahan, LeCates, Wallace, Soumerai, Ross-Degnan, Wharam); McLean Hospital, Belmont, Massachusetts, and Department of Health Care Policy, Harvard Medical School, Boston (Busch); Department of Pharmacy and Health Systems Sciences, Northeastern University Bouvé College of Health Sciences, Boston (Madden); Depression and Bipolar Support Alliance, Chicago (Foxworth).
Psychiatr Serv. 2021 Aug 1;72(8):926-934. doi: 10.1176/appi.ps.202000362. Epub 2021 May 11.
High-deductible health plans (HDHPs) require substantial out-of-pocket spending for most services, although medications may be subject to traditional copayment arrangements. This study examined effects of HDHPs on medication out-of-pocket spending and use and quality of care among individuals with bipolar disorder.
This quasi-experimental study used claims data (2003-2014) for a national sample of 3,532 members with bipolar disorder, ages 12-64, continuously enrolled for 1 year in a low-deductible plan (≤$500) and then for 1 year in an HDHP (≥$1,000) after an employer-mandated switch. HDHP members were matched to 18,923 contemporaneous individuals in low-deductible plans (control group). Outcome measures were out-of-pocket spending and use of bipolar disorder medications, psychotropics for other disorders, and all other medications and appropriate laboratory monitoring for psychotropics.
Relative to the control group, annual out-of-pocket spending per person for bipolar disorder medications increased 20.8% among HDHP members (95% confidence interval [CI]=14.9%-26.7%), and the absolute increase was $36 (95% CI=$25.9-$45.2). Specifically, out-of-pocket spending increased for antipsychotics (27.1%; 95% CI=17.4%-36.7%) and anticonvulsants (19.2%; 95% CI=11.9%-26.6%) but remained stable for lithium (-3.7%; 95% CI=-12.2% to 4.8%). No statistically significant changes were detected in use of bipolar disorder medications, other psychotropics, or all other medications or in appropriate laboratory monitoring for bipolar disorder medications.
HDHP members with bipolar disorder experienced a moderate increase in out-of-pocket spending for medications but preserved bipolar disorder medication use. Findings may reflect individuals' perceptions of the importance of these medications for their functioning and well-being.
高自付额健康计划（HDHPs）要求大多数服务都要支付大量自付费用，尽管药物可能受传统共付安排的约束。本研究考察了 HDHPs 对双相情感障碍患者药物自付支出和使用以及护理质量的影响。
本准实验研究使用了全国 3532 名双相情感障碍患者的索赔数据（2003-2014 年），这些患者年龄在 12-64 岁之间，在低免赔额计划（≤500 美元）中连续参保 1 年，然后在雇主强制转换后再参加高免赔额计划（≥1000 美元）1 年。HDHP 成员与同期低免赔额计划（对照组）的 18923 名成员相匹配。结果测量指标为双相情感障碍药物、治疗其他疾病的精神药物以及所有其他药物的自付支出和使用情况，以及精神药物的适当实验室监测情况。
与对照组相比，HDHP 成员的双相情感障碍药物年人均自付支出增加了 20.8%（95%置信区间[CI]=14.9%-26.7%），绝对增加额为 36 美元（95% CI=25.9-45.2 美元）。具体而言，抗精神病药（27.1%；95% CI=17.4%-36.7%）和抗惊厥药（19.2%；95% CI=11.9%-26.6%）的自付支出增加，而锂（-3.7%；95% CI=-12.2%至 4.8%）的自付支出保持稳定。双相情感障碍药物、其他精神药物或所有其他药物的使用情况或双相情感障碍药物的适当实验室监测情况均未出现统计学上显著变化。
患有双相情感障碍的 HDHP 成员的药物自付支出适度增加，但仍保留了双相情感障碍药物的使用。研究结果可能反映了个人对这些药物对其功能和健康的重要性的看法。
