Effects of High-Deductible Health Plans on Pediatric Asthma Medication Use

Enrollment in high-deductible health plans (HDHPs) may not be associated with changes in asthma medication use or exacerbations when medications are exempt from the deductible, according to the results of a longitudinal cohort study published in JAMA Pediatrics.

High-deductible health plans are becoming increasingly common and while they are associated with decreased medication use in some adult populations, their effect on children is less known. Therefore, researchers examined the association between HDHP enrollment and asthma controller medication use and exacerbations in children aged 4 to 17 years and adults aged 18 to 64 years with persistent asthma who switched from traditional plans to HDHPs or remained in traditional plans (control group) by employer choice during a 24-month period.

The HDHP group included 7275 children and 17,614 adults and the matched control group included 45,549 children and 114,141 adults. Asthma medications included inhaled corticosteroids (ICS), leukotriene inhibitors, and ICS long-acting β-agonists (ICS-LABAs). Compared with control individuals, children switching to HDHPs experienced significant absolute decreases (absolute change, -0.04; 95% CI, -0.07 to -0.01) in annual 30-day prescription fills for ICS-LABAs only. Changes in fill rates for other controller medications were not statistically significant after adjustment for multiple comparisons.

Adults switching to HDHPs did not have significant reductions in 30-day prescription fills for any controllers. There were no statistically significant differences in proportion of days covered (PDC), oral steroid bursts, or asthma-related emergency department visits for children or adults. For the 9.9% of HDHP enrollees with health savings account-eligible HDHPs that subjected medications to the deductible, there was a significant absolute decrease (change, -4.8%; 95% CI, -7.7% to -1.9%) in PDC for ICS-LABA compared with control individuals.

“This cohort study found that in a population where medications were exempt from the deductible for most enrollees, HDHP enrollment was associated with minimal or no reductions in controller medication use for children and adults and no change in asthma exacerbations,” concluded the authors. “These findings suggest a potential benefit from exempting asthma medications from the deductible in HDHPs.”

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Galbraith AA, Ross-Degnan D, Zhang F, et al. Controller medication use and exacerbations for children and adults with asthma in high-deductible health plans. JAMA Pediatr. Published online May 10, 2021. doi:10.1001/jamapediatrics.2021.0747