Study: Diabetes Patients in High-Deductible Health Plans More Likely to Skip Medications


HDHPs require patients to pay for all care out of pocket until the plan’s deductible is reached, and only after this threshold does insurance start to cover medical costs.

A new study from Harvard Medical School found that Americans with diabetes who are enrolled in high-deductible health plans (HDHPs) have a substantially higher risk of not taking prescribed medications due to cost.

HDHPs require patients to pay for all care out of pocket until the plan’s deductible is reached, and only after this threshold does insurance start to cover medical costs.

The study showed that 20% of patients with diabetes enrolled in a HDHP reported skipping medications because of cost versus 16% of those in a traditional commercial plan, which is a 28% higher rate of missing medication for those with a high deductible. Out of the patients specifically taking insulin for diabetes, 25% of HDHP enrollees were not able to afford their medication compared to 19% of those in a traditional plan, a 31% higher rate of missing medications, according to the study.

The team used federal survey data on more than 7000 adult patients with diabetes who were enrolled in a commercial health insurance plan, either with or without a high deductible. The research team analyzed how often patients reported not taking prescribed medications because they could not afford it versus the responses between those in a HDHP and those in a traditional plan without a high deductible.

“Taking prescribed medications is essential for maintaining good health for patients with diabetes,” said Vikas Gampa, MD, a primary care physician and instructor in medicine at Harvard Medical School, in a press release. “Our results show that high-deductible health plans, particularly in this period of escalating prices for diabetes medication, are discouraging patients from getting the medications they need and thus they are placing patients with diabetes at risk.”

Further, the study found that among the diabetic patients studied, those who could not take their medication as prescribed because they could not afford it were more likely to have 1 or more emergency department visits and more hospitalizations per year than patients who were not forced to skip their medications.

“Putting up financial barriers to care in order to save plans money, as high-deductible plans do, not only takes a medical toll on patients, it is also short-sighted because doing so actually increases other health care costs such as covering emergency department visits,” Gampa said in the press release.

The study authors noted that the new data are important for patients, physicians, and policy makers.

“Patients with diabetes should recognize that a high-deductible plan will put them at risk for missing or delaying their medications, and doctors need to recognize that their patients with these plans may not be able to adhere to treatment plans,” said senior author of the study, Danny McCormick, MD, an associate professor of medicine at Harvard Medical School, in the press release. “Ultimately, policy makers need to enact reforms that discourage health plans from implementing financial barriers that block access to needed care, such as high-deductible plans. Our results suggest that policy makers must enact reforms that control rapidly escalating prices for diabetic medications.”


Diabetes patients in high-deductible health plans 28% more likely to skip their medications due to cost: Harvard study. EurekAlert! July 29, 2021. Accessed August 2, 2021.

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