High-Deductible Health Plans Paired With Health Savings Accounts Increased Medication Cost Burden Among Individuals With Bipolar Disorder

Abstract

Objective: High-deductible health plans (HDHPs) paired with health savings accounts (HSAs) require substantial out-of-pocket spending for most services, including medications. We examined effects of HSA-eligible HDHPs on medication out-of-pocket spending and use among those with bipolar disorder. Methods: This was a quasi-experimental study using claims data (01/2003-12/2014). We studied a national sample of 348 members with bipolar disorder, aged 12 to 64 years, who were continuously enrolled for 1-year in a low-deductible plan (≤USD500) then 1-year in an HSA-eligible HDHP (≥USD1000) after an employer-mandated switch. HSA-HDHP members were matched to 4,087 contemporaneous controls who remained in low-deductible plans. Outcome measures included out-of-pocket spending and use of bipolar disorder medications, non-bipolar psychotropics, and all other medications. Results: Pre-to-post out-of-pocket spending per person for bipolar disorder medications increased 150.0% among HSA-HDHP members, relative to controls (95%CI: 109.9%, 189.5%). Specifically, out-of-pocket spending increased for antipsychotics (220.9% [95%CI: 150.0%, 291.8%]) and anticonvulsants (109.6% [95%CI: 67.3%, 152.0%]); the increase for lithium did not reach statistical significance (25% [95%CI: -5.5%, 55.4%]). We did not detect statistically significant changes in use of bipolar disorder medications, non-bipolar psychotropics, or all other medications. Conclusions: We did not detect changes in medication use among HSA-HDHP members. However, HSA-HDHP members experienced substantial and concerning increases in out-of-pocket burdens for medications essential for their functioning and well-being, which could be a financial strain for some people.