High-Deductible Health Plan Enrollment and Buprenorphine Dispensing

Area of Science:

• Health Services Research
• Pharmacoeconomics
• Addiction Medicine

Background:

• Buprenorphine is crucial for preventing opioid overdose deaths in patients with opioid use disorder (OUD).
• The impact of shifting from non-high-deductible health plans (non-HDHPs) to HDHPs on buprenorphine use and OUD care among privately insured individuals remains unclear.

Purpose of the Study:

• To investigate the association between transitioning to an HDHP and changes in buprenorphine dispensing.
• To assess the relationship between switching to an HDHP and OUD-related healthcare utilization.

Main Methods:

• A repeated cross-sectional, difference-in-differences analysis was conducted using the Optum Labs Data Warehouse (2010-2023).
• Included privately insured adults with continuous enrollment and baseline buprenorphine dispensing.
• Compared outcomes between patients switching from non-HDHP to HDHP (treatment group) and those remaining in non-HDHPs (control group).

Main Results:

• Switching to an HDHP was associated with a significant decrease in buprenorphine prescription days (-29.0 days).
• No significant changes were observed in OUD-related outpatient visits or ED visits/hospitalizations in the overall analysis.
• In a subgroup with substantial deductible increases, switching to an HDHP was linked to fewer OUD outpatient visits.

Conclusions:

• Privately insured patients with OUD who switched to HDHPs were more likely to reduce buprenorphine use.
• Significant deductible increases associated with HDHP transitions may further reduce outpatient OUD care.
• Findings indicate that HDHPs may introduce barriers to accessing and maintaining OUD treatment.