High-deductible health plans may create barriers to opioid addiction treatment, study finds

Privately insured patients receiving medication for opioid use disorder (OUD) may be less likely to continue treatment after switching to a high-deductible health plan (HDHP), according to a new study published in JAMA Network Open.

A research team led by CHEAR director Kao-Ping Chua, MD, PhD, analyzed insurance claims from nearly 15,000 adults who were prescribed buprenorphine, a medication that reduces opioid cravings and significantly lowers the risk of overdose. Compared to patients who did not switch to an HDHP, those who switched to an HDHP experienced a 29-day greater decrease in the number of days covered by buprenorphine prescriptions in the following year. 

The study found that switching to an HDHP did not affect the risk of opioid-related emergency department visits or hospitalizations. However, among patients whose deductibles increased by more than $1,250, switching to an HDHP was also associated with fewer outpatient visits for opioid use disorder.

Buprenorphine is considered one of the most effective treatments for opioid use disorder, but consistent access is essential. Higher out-of-pocket costs associated with HDHPs may discourage patients from filling prescriptions or attending follow-up appointments, creating additional barriers to care.

“Increasingly, policymakers are pointing to high-deductible health plans as a solution to constrain health care spending,” said Chua. “However, our study suggests these plans can increase barriers to accessing buprenorphine, an effective and potentially life-saving treatment for opioid addiction. Policymakers and insurers should consider strategies to minimize financial barriers to opioid addiction care for patients in high-deductible health plans, such as covering this care even before deductibles are met.”