The Impact of Expanding Pre-Deductible Coverage in HSA-Eligible Health Plans on Medication Adherence

IRS Notice 2019-45 allows health savings account (HSA)-eligible health plans the flexibility to cover 14 drug classes and other health services used to prevent the exacerbation of chronic conditions prior to meeting the plan deductible. In this Issue Brief, we used claims data to quantify the effect of expanding pre-deductible coverage on medication adherence among enrollees with certain chronic conditions. We found some evidence that expanding pre-deductible coverage in HSA-eligible health plans increased medication adherence in 2022, but not earlier.

Key Findings:

By 2022, there was evidence of a rebound in medication adherence. We found that the percentage of enrollees with diabetes using insulin increased 4 percentage points, and the percentage of enrollees with heart disease or diabetes using statins increased by 1 percentage point. While the magnitude of the effect may seem small, it is important to remember that when medication adherence fell as a result of the introduction of an HSA-eligible health plan, the magnitude of the declines was relatively small as well. Furthermore, the implied out-of-pocket elasticities of demand are closely aligned with previously published estimates.
The lack of a large increase in medication adherence may also be due to the fact that adherence rates were already relatively high, averaging 77 percent to 89 percent, with the exception of inhaled corticosteroids, which are often used as a rescue medication and not necessarily filled in a way that would suggest that an enrollee was adherent.

Our findings may be influenced by the ways in which employers implemented changes in response to the IRS notice. First, while the overall employer response to the notice seemed overwhelming, with three-quarters reporting that they expanded pre-deductible coverage for at least one of the 14 services, we would expect the largest impact on medication adherence for diabetes medications and beta blockers, as 66 percent and 54 percent added pre-deductible coverage for those services, respectively. Less than one-half added pre-deductible coverage for inhaled corticosteroids (43 percent), angiotensin-converting enzyme (ACE) inhibitors (39 percent), statins (38 percent), selective serotonin reuptake inhibitors (SSRIs) (35 percent), and anti-resorptive therapy (29 percent).

Similarly, it is not a surprise that the magnitude of the effects is small, as the majority of employers substituted copayments and/or coinsurance for deductibles when they expanded pre-deductible coverage. Whether employers moved from deductibles to no cost sharing whatsoever varied by the different medications. Statins were most likely to be covered in full, with 40 percent of employers reporting that they did not require any cost sharing as a result of the IRS notice, which may explain why statins were one of the two medications that experienced a rebound in adherence. In contrast, only one-quarter of employers exempted ACE inhibitors, SSRIs, or inhaled corticosteroids from any cost sharing.

The fact that we did not see a change in adherence for most of the medications examined is not surprising. Since 2021 was the first year that many employers expanded pre-deductible coverage, it may take time for enrollees to learn that their health plan has changed coverage for certain preventive services. They may not be aware of the change in plan design, despite employers’ best efforts to inform enrollees of a plan design change that is considered an improvement in benefits.

This study was conducted through the EBRI Center for Research on Health Benefits Innovation (EBRI CRHBI), with the funding support of the following organizations: Aon, Blue Cross Blue Shield Association, Johnson & Johnson, JP Morgan Chase, and PhRMA.

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The im im a - eD p ond ov e e p e r e e d e for for B a a it r uc se , ie sed rions ttt nni e e he ible o d nr nr , is ." ha a a olle olle c e l He nd a Ia Jour v ns lc ses ee eula t ur s t s t m a he na lt a w ov to o h I nc ion for e ser l o e le le re ns d ea f a v r rlis tur ic n t n t ow e tae s ha ha nc a dr d t e tin Christopher Roebuck is Preside nt and CEO of RxEconomics, LLC. 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Neither EBRI nor EBRI-ERF lobbies or takes positions on specific CHF I50.xx; I11.0; I13.0; I13.2; I09.81 c A hr dhe onic renc cMe ond e w diic a tions s m ation a e a as w su nd re eMe d ll. us One dic ing a l U su the c tili h st p za rop tud ion a o yr tw ion o nd as Sp cf d ond ending auc ys c teov d a nd b er ee for H d ee (a P lID tRS h." C), N JA w othic MA iceh com 61 20– 19 69 m -45 . edn oi:10.1 w ce ad s r on e00 leta he 1/ sed jfir am st aa nd .298 fill d exa a .1.6 tm e ine ( 1. on d or 57 • ACE inhibitors. Selective Serotonin Reuptake Inhibitors Insulin & Other Glucose-Lowering Agents w r re ea sea bsound rr eclA a h ind n tin m iv gio etly ic ee n a sm si d te ic n-s t a a co ll a tion a ha nvs w e t r63 tid n eg h ll. p ee rFr e rc nc onst ent e. in, Se of enrpolle úlve es d a w , itah a nd n HS Roeb Auc -ek ligib (20 le 13 he ) a found lth pla an 4 p spe end rce nt less ag e tha point n 30 mi decnu line te in a s choos dherin eg nc a e policy proposals. EBRI invites comment on this research. Effect After 1 Year Effect After 2 Years Effect After 3 Years 24:08.44.04; 24:32.04 Diabetes E08.xx-E13.xx; O24.xx Condition Preventive Care Service For Individuals Diagnosed With Statins 40% 48% 11% I C d anc ft r ong ug erre r a c Ja e la ses e ss nua n ss z iona ym e in c r s us 7y e l B onsu 1, 2019 (A eudg C dE tm )o e (SS ie n tt) h rr Offi ie b for out R a itt o I c s) r- a 11 e sof . p f o -20 r cp r e hr oc sc D 12 onic e k r. ipti p eOffs t re c c on ss os ond e it o w ts for t n it it ing ions hin E he a ff ( a e VB the lt cth ca Is of rD a p H reP e e ut r aha e lt ic sc h, vcre la ipti n.d b ss e on .) e an .nd D Ia tr ss e ug found nde ocUse iadt e ton ha d on w tD Me it ceov h d cd efe m io c e rr a ing le br D e tee r i’a s Sp a r31 b ious lle t , the e e 20 s nding cse onseq 22d . rOnly ug for ue cM nc la indiv e ss eds. e ic s p idu a These l raels - This study was conducted through the EBRI Center for Research on Health Benefits Innovation (EBRI CRHBI), • Beta blockers. t he Th o a hy lth p e pe rla tIm en. nsion me Fu pra the c d rm ic ta of or tion e, t s, a he Ex e 13 mp p ploy a ercn eernt sd tahe in gem p g selves oint Pr de m e clin a- yDe e or in a md a dy he u not rc enc t ha eibl vte o d de one ysl Co ipid a g eo m v oia de jm ob rea deic g da uc e tions a i ting n , a HSA t he 10ir p e em rcp e- loy ntae ge es (2020) (2021) (2022) Dependent Variable CAD I25.1x; I25.7x; I25.81-I25.84 Congestive heart failure, diabetes, and/or coronary artery Internal Revenue Service. 2004. "Part III - Administrative, Procedural, and Miscellaneous: Health Savings Accounts - I Y d inc ide e e nt d tlude nt , uc r w ifi o thil e ible duc fin dSe e a a e w r s ha nc m vt it ic p ia ion h a e loy v l st s. ing e cC rom re ong s c a ss b c, ould o ina rw e rrss or e t ion o s iona in se pc ond e dl B nt is f c ing e iv udg op aize se a ce hr yt ctm he ont onic Offi e nt us rol, c s a c e eond . of inc nd Re p it rtc e rion for roins e a ie v ses v ee nt ur diiv n hosp a fr te nc he om ser e t he w vitould ic raa e liz p s in non e a ut inc tions ic r ec, a la -se a H ss nd SA p in 201 re e p xa m laium c ns e9 (t r, b s b not ahe tion o y a1.7 p bll e aseline f he me pra loy clt e y h d nt e era .s ha is rMor )p w avre e e it r ie r e d e on s, cee nt so. ly, Angiotensin-converting enzyme (ACE) inhibitors • w ith th Inha e fun led d cing ortic su ost pp eor roid t of s. the following organizations: Aon, Blue Cross Blue Shield Association, Johnson & a pb oint out dtrhe op cin a hange dhe . rence to 2018 diabete 2021 s medications, and no drop in adherence to asthma/C 2018 OPD or 2021 depression medications Antiresorptive Therapy Suggested Citation: Fronstin, Paul, and M. Christopher Roebuck, “The Impact of Expanding Pre-Deductible Eligible Health Plans on Medica dit seion ase CHF Adhere I50n .xxc ; Ie 11 .0; I13.0; I13.2; I09.81 Additional Qs & As, Notice 2004-50." Retrieved from https://www.irs.gov/pub 4 /irs-drop/n-04-50.pdf. Endnotes Beta blockers 24:24; 24:08.08 a r The pe n EB atratine ic IRS ula RI d r ht n st fo ly ot udy tr p for ic t:// he e us w tm hose ew e a ns d w y uin .c c m la w b ov g im it o.g h ch e as n ov su d aly a r / conic si th e si ats. Fina e tm s o /de m p ee loy std fa im llic e y ult a r , as t l c tin a /f eile ow ond the d s/ a dit c rit e d b ion ion to co ff ofile ceha s a ct ngi s/ of nd ang telow t nt xpa ac inu th he end m rous P ir hous eing nt pla s/ p D n e 4 rhold C e 37 d, - ed w 41 si e g e d inc - n to inc uc Me als om to ible dic e ca r s e .e lOff ca nt ov P te iv e se e d e r ize a r tas -g r- d e e t11 he ic vbie hot -e 29 us w yond e om -e12 d of ous m lit .p IRS N e p drrf. a e tvur e e ot a nt esu ic iv ha ere e20 s of 19- Johnson, JP Morgan Chase, and PhRMA. The • Me Nd uI ic m ns a br e uli e r o n a Pfr e pnd rsc escr ripti otihe pon tio rn g D sluc rug, ose Im -lo pw rov ere ing mea nt g, ent and s. Moderniz0 a.t0 ion Ac 2 t of 2003 (MM 0.A 0) 6 included a provis -0 ion th .10 at created when health plan Ane ti-nr Reolle sorpe tive s w The er ra ep y switched to an HSA 40% -eligible health plan in 2007. The 54% lack of a large increase 6% in Antiresorptive therapy Osteoporosis and/or osteopenia 60% 45% CAD I25.1x; I25.7x; I25.81-I25.84 Covera5 g5e .1 in HSA % -Eligible Health Plans on Medication Adherence,” EBRI Issue Brief, no. 611 (Employee Benefit 39.8% 38.6% a I ser d 45 By td e is m he v P t o ic onst a ra e e ls 116 P s for n ul Fro o rce o rw a p c t o or w la ed rseve the ts io h noti ses ns t nr ha e o rt fa tof P in, P d l sele D ng a rm e C ys a e t= sons c ha co h.D., d t iv ic 0.8 v te a e t. rlthe y 0 a e iFi ons d E low r(d s w st P mplo e . , D e m The t C rehe ing a ll a )nd yim ye s cm fo ost a pe a rac y Ben c p ount sh td r e on o asc rso ing e r v pipti a fi rb e rt ia e for m R on cb ium a le e us hi d s rg of e s of ugs e h a t-30 he v 0 rch I a .e ha - 0 lue d xpa I0RS a s g y c nding ns a e hr nd ne ot onic t jus itut ic ra e tp lly e r ha d d e e is b -, ts le e d e he a a e ese n foun d nd rg a uc -it 0 p m im .t e 0M. ible a ut 1ize na d ic C d g tcc o ov e hris la itm b .ss e e e Se r - a nt rtspe e g op c la e ond m tc the e iv o ific d , e11 ic ly a r a p s he 0 6 d Ro tine r .ions e 00 sc re la aug rlt buck, st ipti c h p a ic cn la on . la T ss n he d e s rs ug what • areSSRI coms m . only known as high-deductible health plans (HDHPs). At the time, these plans had to have a deductible 49.2% med B ic ea tIa tnion a h ba lo le cke dd co he rsrr tie co nc ste e rm oia ds y be due 5 to 2:0 the 8.0 fa 8; c 4t8 t :ha 10.t0 a 8dherence C o ra nt ge A e40% s w st stih vm e e a rhe e a arlr t e fa aild uy re r a en la dt/iv ore co ly rhigh, onar J4 y 5 a a.rv x te e xr ry ag ding isea se 77 percent Research Institute, June 27, 2024). 36.8% Internal Revenue Service. 2013. "Preventive health services required under Public Health Service Act section 2713 and 1 De 50% yo, A R. dhA e., reD nt. (C P. DC Che = r 8k 0in, a %) nd M. A. Ciol. 1992. "Adapting a- 0 C .lin 01ical Comorbidity -I0nde .02x for Use with IC -0 D .0 -9 1-CM In 2022, 57.9 percent of individuals with health coverage through a private-sector establishment were in a plan with a m Ph.D., r fil m RA els a e la N k a .t e D nin e d it H g t R e e o ful a ac x lt si ly hr h I Eco e rim onic ns to pnomics ur roffe ov dais nc ee r a a e pd se rE he e , xpe v m L ree a LC nt nc rna im ive g e e , e nt ser rm e d e ev uc nt st icim e e m s on ta e he td eic dra a is t the p k ions rof e e -d la a in H e d st d vic u eSA c irtse ty ible -tehe o ligib b b ae a lt si le h o -s in HSA 0.17 he uta c lt ( om Ma h p e nni p la s, a la ns ng ns nd, w , e it oul t in som is ad l. j , us b19 et e r87 a e s e cla a ; tses, N iv asy e ew ly r for hous e sm d uc eam e ll, r e p ee loy ta xpe a nging l., erndit s t 19 o 93 fr urom e ). s 35% of aB t • lle ooadst S pt ra $1 etssu ins ,000 . r e m for on iindiv tor idual coverage and $2,000 for famH ily yp c eo rtv ee nr si aog ne (see Appendix Figure 1). As will be discussed to 89 pG er lu cco ent se, -lw ow ith th eringe a e gxc ene tsption of inha 68 le :2 d0 c :0 or 0ticosteroids, whicD h a iabre et eoft s en used as a rE e0 sc 8.ue xx- E m 1e 3d .xic x;a O tion a 24.xxnd not 30.6% preventive care for purposes of Health Savings Accounts." Retrieved from https://www.irs.gov/pub/irs-drop/n- Beta Blockers 29.6% 33% 59% 9% Administrative Databases." Journal of Clinical Epidemiology 45 (6): 613–619. deductible that met the deductible requirements to be HSA eligible. However, we do not know how many of these enrollees a ( 1.3 In a L d40% eop etn o te a tt4.7 p he na al. ly ,st si 2013) e rs of r acte ent g29 y .. in oth thera ep re tu ytpic e s of classes, healtRoe h pla buc nsk . (2012) derived t30% he elasticities of insulin and statins to be -0.12 and in m In or ha e In l ed su de lco itn asil b rtico est low ero , id HsDHPs may provide 08 c :2ov 0.e 1rage of certain p Asth re D mv ia aebnt etiv es e services prior E to 08 t.he xx- E sa 1t 3is .xfa x;c O tion o 24.xxf the health Copyright Information: This report is copyrighted by the Employee Benefit Research Institute (EBRI). You may necess An ag riily ot efil nle sid n- C in a on vw ea rty in tg ha Etn zy would me ( A su Cg Eg ) e In st h it bha itotr s an enrollee was adherent. 24.6% 13-57.pdf. For each therapeutic class, our task was to analyze prescription drug utilization and adherence for the two distinct were in an HSA-eligible health plan. Some were enrolled in a health p25% lan with a health reimbursement arrangement (HRA). Three annual measures of medication utilization and adherence were used as dependent variables: (1) the number of F31.3x-F31.6x; F31.75-F31.81; -0.05 In su on lint a he nd int oth ee ns r g iv lu eco m se a-rlg oin (r werin e gspe age cn tiv tsely). These e 2st 7.i1 m %ates a Dialign betes quite well with those calculated for those drugs in plan d cop e Nd u yuc m , p bte r ible int r o, f. p or Ernr e d scr olle ow ipnloa e tio s in p nsd tla his ns r e tha potr tm solely for eet the 26.se 1 % p a end rsona othe l ar -n 0rd .e 0 q nonc 9uireom mem nte s a rcia rel use allow 0, .0p e 1r dov to ide op de tn a hatn a dll ha cont -0r .0 d ribut 4 cop eie ts o ra e tain 30% Selective serotonin Fr onstin, Paul. 2002. "Can "Consu2 m 3.e 7r% ism" Slow the A p Ra pe te n d of ixH F eia glt uh B re e 1nefit Cost Increases?" EBRI Issue Brief, no. 247 Insulin and Other Glucose-Lowering 20% W Othe W cohor e it h I rrs etc RS N s of w ent erly e indiv ot in st ica e he idua r t20 a elth d1 ls 9 to p -in 45 la ec ns xa lude in p m thine a d la t in t c me e the , he t H the im SA st 2 p -udy: th d 8 e ae :ligib c 1d t6 uc .of A 0le tib 4t .ose 2 he T he le 0 re a I e RS ltq nr h p A uire olle n la ot me n d ic G s e in P nt a L on rb eP ut D A no Os p ela ma pw rN n e a e y nd ssi a b n ha C o lre tn olle hose v E e to no ea s. d t e o nr me Fr polle tonst t ao F d m t3 he in a 2or in HDHP .r 0e x re nd -flexib Fq3uire Volk 2.7 s, w x le me ;ov F bnt 3 hic e (220 ne s.,9 h a ;s 23 fit u Fllow c 3 a d h 3 )e . a x si ee x sxa g ; d the n m p , ri e ne - d Congressional Efforts to Further Expand Pre-Deductible Coverage 30-d Ra ey tP in a ro o d p pja us otrh ttiy o en scr d op fe rd e ea n sc iys nr gipti covons fil ered (P leD dC for ) the cond 30%ition; (2) theD 0 P i.a D 0b 0 C e tfor es the condition, 60% 0.0 w 0hich represents the 0.0 fr 011% action of A our s m pe re nt sent ione w d or ab kov (-e 0.15 , we a a nd lso- 0.06 exam ).ine d three therapeutic classes not specifically afforded pre-deductible coverage in 18.8% health sa reuv pings a take inc hc ib oiun tors t ( (S HS SR AI)s) on a tax-preferred basis. Thus, these plans are also commonly known as HSA-eligible Kaise arny Fa am nd ilya Founda ll cop Ag yern tight ion. ts a20 nd 15 ot . he Prre v ae pnt plic iva eb Se le rnot vice ics C es c ov ont ere ad in b ey d P the rivraetin, e Ha end alth P you lam nsa y unde citer or the q uot Affe or sm dab ale ll p Coarrte ions Ac tof . 20% (Employee Benefit Research Institute). 15% F34.1x; F43.21; F43.23 d t offe re he esd trictio uc r im ing tp A ible a dn m c ht e o or c rof n e ov e n p ttp re e he (r r P v ot aD e g not e ntiv C ec = tb iion for c e e 8 e g 0 s inn % on erv ) in ic e cnr e g es rollm in 202 .t ain m ent 0. We e d in icH al se SA fir-st r ev ligib p ice ers t for le hr he moug e ad lt h h a a 0 p 1:1 e .la 0v 0 ns alue xaand -cb t a m found sed atc ins h b tha ur eta tw 0 nc w .e 0e e e 1n P a dree P si O not gn (V a nd see -B Hing ID DH ) m Pp 0 or la m .0 n st e e 1m eb nr ruc eolle rs tur w ee it s in .hin As Statutory HSA Limits, 2004–2024 days in t Peak he flo w p e mre iod ter that the patient had at least one drug for A the sth m cond a ition on hand; and (3) a flag indicating a PDC of HDHPs — calcium channel blockers (CCBs), angiotensin receptor blockers (ARBs), and serotonin and norepinephrine Figure 3 healtth p he la rens por . I t n pr2024 ovide , d the tha se t p yla ou ns d o mso ve ust ha rb va et im a d a end ducw tible ith p of roa pte r le c ait st a t$1 ion. ,600 Any for us indiv e beidua yondl c the ov esc raop gee a of nd the $3 ,for 200 egfor oing Washington, DC: Kaiser Family Foundation. Retrieved from https://www.kff.org/health-reform/fact- 10% Heart disease Ix.xx Building on the momentum of Executive Order 13877 and IRS Notice 2019-45, Sens. John Thune (R-SD) and Per-Person The H t ehe a SA 10% c h th G m -fa e lu a ligib c co re tk rt m ea ha tle e p for te t e he ut re m ic a Hlt SA pc h p loy la -e ss e la ligib r ns s m on le w b ov it ahh condit seline e ed a lt th p ow (a 20 la ions rns d19 c g ov )su rvo e a cw rh a lue ing s, it s of s he se isr v a tim he ic rte p d s on or follow isteaant D se, aing ia p tha b rhy e ev tt -e p d at se r e he ia r dtuc b se elns e ts: m ible pion, lans b ad a le us e si , ps onc e a r e g tss his e ion, g e rflexib oup the dia y ( ili b w 18 tey et– re te 24 s, a o aa , llow llow 24 nd– e a 34 d for st , thm o 35 e d ff a– o e 4 tcha so 4, tiv n in e Statins 24:06.1 80 2 percent or higher, a commonly used threshold for adherence (Roebuck, Liberman, et al., 2011). Proportion of days reuptake inhibitors (SNRIs). We included these classes to test our model, as we should not see an impact on I fa RS N S m ee ily http ot co icv e se : / 20 r/aw g 19 w e.w - 45 E .irs nr a .ollm g llow ov/es pnt ub he in /a irs lt high h sa -dro-p v d/ings a e nd -19 uc- t45. ible ccount p d pfla . ns (H S aA cc )- ount e B ligib as s e le for li n he ov ea Sa e ltrh p one mla pns l-e M ha C a tlf of he x h im a flexib r uta m hose c te Oili u rttiw y -s o it ti tfo h p -c s c o r (i iv v n e a r t 2 e 14 0 he 1 d 9 a r) lt ug h cov class ereas ga end Fronst rein, P quir shea es E ul, a et/pr BRI nd e In’v s p he a A lnt e . r dior Ma iv Ce o rr-e tk iser co xpress Fe stv endr ic roie ds sic p -c e ko . rm v20 eis r21 e sid on. . -by "EFor - m pp riv loy paete rem r- he Up issi atons, lt ah ke -p of la ple ns Par/. 5% se e -D ce ont duc ac tible t EB RI Cov ae t rp ag er em fo isrsi P ons@e reventb iv ri.or e Se gr . vices in Beta Blockers 26% Diabetes 61% E08.xx-E13.xx; O24.x 13% x 5 Tom Carper (D-DE) introduced the Chronic Disease Management Act of 2019 in the Senate (S. 1948 Ca )t, ch follow -up ed Hemoglobin A1c testing Diabetes t c 45 he he om a – lt 54 p eh ma a s a , st55 .t W a na – 64 e cg ra it e ), ls ic m g o a e e l p nt e og xa efor rrm a iod p ine a hic ll of d b r e tt eim he ne gion (N e fic im . W ia pr a he ie or cts. n th tof he A a te the st a A r, g C not Mid e At e p ic d w ae ss e st on st e ra , dte S e in 201 nr out gy olle h, explor e 0, it W ce ost st ing in ) , c sh lude C ca ov ha ring, e rd ls r ap on grw e ov it C for is h th om ions cor e er b tk ra idit e ein hig q y ui yq rue Iing nde h st -v ion b tx (0, 1, ha alue t e e , m ing clin p 2, 3+ loy ic wa he elly r) t s a ,he P n r d D w Ce covered is now used, for example, by the Centers for Medicare & Medicaid Services as a quality measure component of 1 me0% dication adherM enc ine im for um tD he ese duct mie bd leications M as a axi m re usu m lt C of on tthe rib u ItRS noti ion0% ce. As eP xpe ock ct ee t d L, im the it IRS notice had no impact on Number of prescriptions -0.18 -0.06 0.08 ( ot Fihe gur r e he 1) alt .h services used to prevent the exacerbation of chronic conditions prior to meeting the plan deductible. In HSA-Eligible Health Plans." EBRI Issue Brief, no. 542 (Emp Cloy HFee Benefit Re I5 se 0.a xr xc ; h I I11ns .0;t it I1ut 3.e 0) ;. I 13.2; I09.81 3 Contribution See https://ahiporg-production.s3.amazonaws.com/documents/202109-AHIP_HDHP-Survey.pdf. Ib nty e rtn he ati o int narl od nouc rmt aion o lized f ratthe io (c IN oR m ) p te ast nion b ing ill in the House of LiRe verp d re ise sent asea a tiv nd e/s (H or ble .R. edi37 ng 09 diso ) b rdye rRe s ps. Earl Blumenauer CalciuD m e d ch uct an ib nle el blockers Copay Coinsurance Deductible Copay Coinsurance a indic c he a re tae lt se g a h p or te eing y d la (he ns 0.00 fe ac w lt ov – h se e0.19 re e r nr rcv e , olle ic r0. te as p 20 in p es in HSA – r0. io rer39 v te o , nt 0.40 m -iv eee ligib e – t ser ing 0.5 le v ic 9, 0.60 the he es in full a lt dh p ed –uc 0. la.t 79 ns ible The , w 0. it w se 80 h d illinc –p e 1.00 rd lude od ucuc t )ible , ser ea nd m s for vor icae e s su fla ser eff ge v cfor c h a ic tiv e s su n s s ee , w c cc lin r us e h a e ic e nin a s ins rll e y gq s for nua u uli al to 1 n a nc ca e nd nc d if t d inh ee rhe si a ag nd le ns pd aot tw ie he it nt hout r’ s the St Ra ep Prr o Ra opro t Availabili trings c tion ofa d lc aula ys ty co tion f :v e Thi re or ds r (st P ea D pnd C or )- t ais lone ava p ila rebsc ler ipti on on thed int rug er 0p ne .0 la 0 tns a ta w s w ww ell .ea bs Me ri.org d 0 ic .0 a0 re Advantage Plans 0..0 1 t Lhe ee , us Joy L e of ., the Ma se tthe me w d ic L. aMa tions cie . jThese ewski, fin Shv dings a eta S. rRa e not ju, sh Will ow ian in m H. the Shr figur ank, ea s.nd Niteesh K. Choudhry. 2013. "Value-Based 24:28; 24:08.12 this Issue Brief, we used claims data to quantify the effect of expa Dia nd being tes pre-deductible E c0 ov 8.e xx r-aE g1e 3 .on xx; m O2 e4 d.ic xxation Selective SeroI tn on d in ivi Rd eu up a ta l ke InhibiF toa rsmily Ang In io dtivi en ds uia nl- Family Individual Family Selective Serotonin Limit Low (C -dC eB nsi s)ty lipoprotein (LDL) testing Heart disease (D-OR) and Tom Reed (R-NY). This bipa 25% rtisan, bicameral legislation would 63% give HSA-eligible health pla 11% ns Adherent (PDC = 80%) 0.02 0.01 0.03 fir c fun he 4or st atd lt ic a b h condit os m aseline e te nt roid ally ions fil s , a l w a lt, nd ea v rs b ing afound cceina ty he ond t io tor ha ns Q1 o igina t, ca ost nd f 201 l int sh be ira nt 9. M trh cont ing and ash tcspir rh r ift ol. ea it d P t e la of fr s r n sp om ta he nge d onsor se ed dp uc la frs ha tom ns ible . v A 83 s t e d op o b pe e cte op rion o c n ea p nt yrm ohib f volu for ent it as a e nt nt dir a nd fr e ry sor om , coins cp lin im tiv ic ur p e aosin a lly the nc nua g e ra a a pm ny n yc ong t eo for d99 e m e xpa nr p of e oll nd rc ce ost e e ent d s (SSRIs) Fr Sonst ee the in, P I li ns te aur ul, a raa ture nc nd e re D Ev d eie si ew n Vol gs n: Q in k Bund ua ovlit . 20 y o rf I23 m (2012) p . r"ov The e m aI nd e m nt p Ag aBcrut ta w of N ao l, Expa C Most aznding ure Sanko, vings." Pr e and -D H e Me d euc ana ltth Af ible che fa mi Cov ir(s2017) e 32 ra g(e 7 a )in HSA s : 12 we51 ll a --E s 12 ligib re 57 se. le arc Hh ea in ltBrot h Pla -ns CAD I25.1x; I25.7x; I25.81-I25.84 Antiresorptive Converting Enzyme Inhaled Glucose-Lowering Reuptake Inhibitors adherence among enrollees with certain chronic conditio Fns ig.u W ree 1 found some evidence that expanding pre-deductible 2004 $1,000 $2,000 $2,600 $5,150 $5,000 $10,000 $500 Selective serotonin reuptake inhibitors (SSRIs) Depression Figur ae d d 4 p itiona resent l fle s e xibilit stim ya tto es prof ovtide he im cov pe arca t gof e for the se IRS noti rvices tcha e on t mp arna esc ge ripti chr on onic dr ug cond usit eions and p ard ior he r to enc me e e in 202 ting the 0, 2021 plan , and H in HSA sh for SA a r st -ing e aligib t-ins e(ligib i.e . le., Fi he le na d ea he l sa d ltuc h p alm t th p ible la ple n la , b si ns ce ze op ne fsa or fit y r a m ang d ee num nt e sid s, g ns fr bor e om r ha cof oins s t 37 ser he 1 ind ur v a p icnc ot e iv s im e e idua nt ) on ia pls l to mi ap c in e taerd tic ab tipa c iga yh o Int tRS N e f th s r cos e eot c tP e -ic riv Pe e O ing la 20 a te nd 19 tdhe non -H se 45 DH . -ser a The Pd g v he ic roup sa rees. nc m s fo e e , sh e r nha ift ant w ir nc a es not e so p ra ptt ie iv ob nt eser - ved Goldberg, Chandra, St Ha and tines l, Tfh o ae nd r rH a p Kols ey artta Dd ise (2017) (a Ase CE); In Cha hibnd itora rs, Grub Beetr, a B and loC c k H Mc e FrKnig s C ht o Be r( ti2010) tca o s Bl tIe o 5 ;rcke 0 o C .ix he dxs rs ; rne I1f1 ow .r 0 H ;e It e 1A a a 3g l. rt .0 e ;(n D 2008) It1 is se 3.2 a;se ;I 0 Colli 9.81 nsI, n sulins (SSRIs) Statins d On oi:10.1 Enrollm 377/ ent hlt a ha nd ff.2 Cost 012.09 Sha0 ring." 2. EBRI Issue Brief, no. 587 (Employee Benefit Research Institute). coverage in HSA-eligib Pele rc h e en at lta h p ge la o ns f inc Perres ao sed ns m E en dr ico altlion a ed id nhe ar H enc ig eh in 202 -Ded2, b uctut ib lnot e H ee aa rli le th r. P lan Inhaled Corticosteroids St2005 atins 1,000 2,000 2,600 5H ,1 e5 a0 rt disease a5 n,d 0/0 o0 r diabetes 10,000 600 Angiotensin receptor de Ad nguc iott eible nsin . Co The nvertib nill g E w nzym as er e (Aint CEr )oduced in the Senate in January 2020 (S. 3200), April 2021 (S. 1424), and March 2022. After adjusting for the characteristics in Figure 3 using the difference-in-differences multivariate models described c for ent ee nr reolle d out es in o come the s, a r t llow y HDHP pe s o forf he low PPO aelt rh p pre la m HDHP ns ium . Ys t et, ha the n mo PPO IRS st npot r HDHP e ic fe er r ae pd p PPO e pa rov rs t ide o HDHP ha r ov re g aha niz d PPO a a tions neg ( ligib P HDHP POs le )im and pacPPO he t on alth ove HDHP rall costPPO HDHP PPO HDHP PPO t herapy to 15,330 in each statin c2 ohor 4:32t..0 8; 24:08.44.08 Rasmussen, Beutel, and Doty (2015); Fronstin 25% and Roebuck (2019);D Fron iabetse tin s and 59% Roebuck (E 2013) 08.xx;- E Fron 13.xsxtin ; Oa 2nd 416% .x x Roebuck Table of Contents Number of prescriptions -0.39 *** -0.18 0.00 (HDHP), by Employer Contribution to HSA or HRA,* Among Those With Inhibitors 2018 2021 2018 2021 blockers (ARBs) 2006 1,050 2,100 2,700 5,450 5,250 10,500 700 On Se Sop urtce em : b hte tp r s: 7, 2022 //vbidce, ntJud er.og re g /iRe nitie ad tiv O’ es/C honnor sa-high of -detd he uct U. ible S. -hD ea is ltth r-ic pt la C ns- our 2/t for the Northern District of Texas found a key abov20 e, 23 we ( S. found 655 )som , and e e itv ide was r nce e it nt ha rod t euc xpa ednding in the p rH eouse -deduof ctible Rep r ce ov sent eraa gte iv in HSA es in Ma -ey ligib 2021 le he (HaR. lth p 35la 63 ns ), inc buil re da ing sed on the Ma Fronst nning, in, P W aul, a .G., J.P nd . EN de ew n Vol hou (n=k se, 3ov 71 . N )20 . D 23 ua . n, "The E(.B nI = .m 5 K ,p e 3a 1 e4 c le t ) rof , AE . xpa Leibo nding (nw =it 1,z, 1P 7a r7e nd )-DM.S. educt (Ma ible n=r 1q ,7 C uis 4 ov 1. )e19 rag 87 e . in HSA “H (e na =lt 1- 1 h I E ,5 ligib 2 ns 3)ur lea H nc ee a lt a(h P n nd = 3 la t,he 0 ns 1 9 ) (n=6,440) (n=15,330) m sha aint ring ena as a nce por ergca eniz nta ag tions e of t(ot HMOs al sp)e , nding and su on bst aa num ntiallb ye rre o df se ucer v aic gg ers im e Cg Aa D p te a chte ea dlt b h ca y the re n e Iot 2 x5 pic .e 1e ndi x. ; IThi 2 tur 5.s 7 ex s. m ; Ia 2y 5 .b 8e 1 -b I2e 5c .8 a4 use (2020); P rFron oporsttin ion a ond f d aR ys oeco buc vek r e(d 2014) (PDC ; )Fronstin and Roebuck (2016) -0.02 ; * Fronstin, Sepúlve -0 d.a 0, 1and Roebuck (2013 0.a 0)0 ; Fronstin, Key Findings: Private-Sector Health Coverage and Employee-Only Coverage, 2016– Introduction .......................................................................................................................................................... 4 2007 1,100 2,200 2,850 5,650 5,500 11,000 800 60% 50% part of the preventive service provision unconstitutional. Specifically, the decision in Braidwood Management Inc. v. A IRS g ge S e (y ruida o eta orn sinc n ) ae n d a nd pre 5v 5ious .8 v5 e5 rsi .8ons to 5 fur 1.7 ther inc5 r1 e.a 7se p5 re 3- .7 deduc 53t.ible 8 cov 43 e.r3age F 3 for 4 13 .3 .c 3 xh -F r3 onic 1.65 x d ;0 is .F 23 e1 a.se 75-m F 53 0 a 1 .na 2 .81 g;e m 47e .9 nt. 47.8 38.5 38.6 52.4 52.4 S mtea dtic ist a Atd ion a ica herl eAna d nthe (PrD lys enc C = is e 8 in 202 0%) 2, but 0% not ea 10% rlier. 20% 30%-0.01 40% 50% 60% -0.02 70% 80% 0 90% .00 100% employeron D s w em Use earnd e of m for or He eM a lik lt eh C d eic lyaa l C tro e a sh S re e ift r: v E ic cv o eide st s." sh nc Ea e Br RI ing from I ss fr om ue a Ra B drn e ie d dfom uc , no. tize ible d 58 s t E8 (E xpe o cop m rim p aloy e y 4nt m 2e .e .” 9ent % A Bsm e a ne end rfit ica c Re oins n Ec sea ur ono racnc h I me ic ns ins Re tittv u eie taed w ) . of 77e (lim 3): ina 25t1 ing - Sepúlveda, and Roebuck (2013b); Fronstin, Roebuck, Buxbaum, and Fendrick (2020); Goldman, Joyce, and Zheng (2007); 2022 48.6% Much work has been done to examine the impact of the IRS notice on the response of employers and health plans, as 2008 1,100 2,200 2,900 5,800 5,600 11,200 900 Backgrn ound 18–24^ orep i................................ nephrine reuptake 0% 0% ................................ 28:16.0 0% 4.16 0% F ................................ igure 0% D 5epressi 0% on 12% ................................ F3 12% 2.0x-F32.7x 2% ; F3........................... 2.9; F3 2% 3.xx; 6% 6 6% 23% 23% 0% 0% B Ae c50% c cor erd ra ing refe to rs t Not o ic te he 20 p19 art- 45 of ,t he the A lis CA t of tha ptr e re vq euir ntiv ee s c ser ovv eic ra eg s t e ha wit t hout can b ce ost cov sha ere ring d prof e-t dhose eductpible rev e w nt illiv b ee ser rev vie icw es t edo on w hic a h • By 2022, there was evidence of a rebound in medication adherence. We found that the percentage of enrollees 277. 40% 36.1% it Triv . edi, Moloo, and Mor (2010); Wharam et al. (2017); and Wharam et al. (2018). Mean va80% lues across groups within therapeutic class for all variables used in the analysis are reported in Figure 3. In 33.3% well as t inh he ibi tim ors pa (S cN t R on Is)premiums. A 2021 EBRI survey found that 76 percent of employe Fr3 s w 4.1it x;h 200 or F43.21; Fm 43 or .2e 3 employees Glu 25–34^ cose-Lowering Age 0% nts 0% 2% 2% 0% 0% 10% 10% 3% 3% 6% 6% 14% 14% 1% 1% 2009 1,150 2,300 3,000 5,950 5,800 11,600 1,000 Specifically, in 20P 20 re , v the en only tive st C aa tis rte ic M ally e a sis gu nirfic es ant C o eff ve ec rte s w d o ern e found a Prefor -D e inh du ac letd ib clor e tB icost ase is roid ins a 20 nd 21 st 3 1a .0 tins % . Fronstin, Paul, and M. Christopher Roebuck. 2019. "Do Accumulating HSA Balances Affect Use of Health Care Services t phe er iod U.S. ic b Pa re sivs. e nt In fa ive c Se t, rtv he ice g s uida Task nc For e spe ce c(ifi USP cally STF st)a — te s t a ha group t the t he pe rAiod geic nc rye for vie w H e isa lt ehc xpa er ce te Re d tse o a oc rcch a ur nd ap pQua roxim lity a tha ely s b ev ee ern y 40% with diabetes using insulin increased 4 per3 c5 e.nt 3% age points, and the percentage of enrollees with heart3 0 d.is 6% ease Source: Fronstin and Fendrick (2021). Data and Methods ............................................................................................................................................. 7 32.4% 32.4% 5 addition to th N 35–44^ otes: e IC m D e =a Isu nte rre ns e ati1% o m na plloy Cla essi 1% d in t ficathe ion m o 13% fa D tc ise hin ase g p s. 13% rocess, m 6% ean ag6% e (cont24% inuous), 24% polic 26 y.hold 2% 16% er (indica16% tor), 17% 17% 26% 26% 11% 11% Number of prescriptions -0.03 30% -0.03 0.08 inc Th re ea Cha sedrls the on num Como be rb r id of ity d r In ug ds a ex ( nd CCI) seris v ic a eme s ca ov 2s9 ure e .7r% e o df p he rea-lth ded suc tatus tible . Mo in HSA re spe -e cific ligib allle y, he it a islt a h p we la ig ns hte ad s a in d re esu x tha lt of t pIre RS dicts 2010 1,200 2,400 as a R 3,e 05 s0 ult of IRS 6, 1N 50 otice 201 5,9 9- 545 0 11,900 1,000 Otherwise, there was no evidence of changes in medication use or adherence for the other medications examined. With fiv C Mor a Nut eo e w hor nc e thous o rize e 10 lus ca e e dnd nt y , ion b eJ. ly a ySp , ra ts. Fr he n e d nding For onst U. the S. p in a a ? IC ns t"ie ong nd E ur nt Ba R s a r Volk nc e I ss I nd e ss ov tE ue o e xpe m ( c 2 B onv p 02 r rloy im ie3b) e e fe e , ne nt rno. s si a G xa lik n 48 roup c m e e2 (E , ine 19 10 . d 19 98 m ytp 93 e h — loy a e. r s m im a Fr ess ep e a a igns a e By c eFo tne b of e rfit A a tr he ll? a Re long t ing L not sea e ss tof ic im rons fr ceh I “e A on t”ns o or om us w tit a “ e ut B i ttof ” he e for .) .he RA su aN lt ch ca D h co He rve ae ltr se h I ag rv e ns ic de ur esc a . is nc Ov ions ee ra , ll, or diabetes using statins H D in Hc Pr O ea nlsed y by 1 Hp De HrP c e Wnt itha Eg m ep lp oye oint r Co . nW tribhil utio en tthe o H Sm A a org H nit RAude of the effect may seem small, 30% P 45–54^ roportion of days co 31% vered (P 31% DC) 43% 43% 40% 0.00 40% 34% 0.00 34% 42% 0.42% 01 38% 38% 25% 25% 42% 42% 70% d eductible level (continuous), and PDC (continuous) are also reported. American Society of Health-System Pharmacists. "AHFS Pharmacologic-Therapeutic Classification System." ASHP. Statistical Analysis ................................ 21.6% ............................................................................................................. 8 N risot k ic oe f d20 ea19 th -w 45 ithi (Fr n onst one y in a ear nd of Fe hondr spita icli kz,a 20 tion 21 fo ). r Ppra etie -de nts duc wtith ible s p ce ov cific era cg oe mo wrb as oft id co end n a itid od ns ed . It for is he wid ae ltly h ca use re d se in rthe vic ees r xta ent lated 2011 1,200 2,400 3,050 6,150 5,950 11,900 1,000 respect to inhaled corticosteroids and statins, we found decreases 20% in the numbers of prescriptions filled, a decrease in Experiment. Cambridge (MA): Harvard University Press. g the ive st n th udy found 55–64^ e pace of tha retsea bertc w 68% h o een 2018 n pla 68% n d aend sig20 n a 21 42% nd , tm he e dIic RS noti a 42% l innov cea 54% le tion. d to Ther m 54% ore e a of rea 20% a n lrinc ead re ya 20% e se xain mp the les of 37% useser of vtic hr e 37% e s t e ha of tt he m 33% a seve y n 33% 12% 12% 46% 46% Adit h eis re im nt (p Por Dt C a nt = 8 t0o %r)emember that when medication ad 0he .00 rence fell as a resu 0lt .0 0 of the introduction o 0.0f a 1 n HSA- In response to IRS Notice 2019-45, three-quarters of large employers and health plans offering HSA-eligible health https://www.ashp.org/products-and-services/ashp-licensing/ahfs-therapeutic-classification. 20% literature as a gauge of general health status. Medical conditions such as diabetes, cancer, and heart disease are included. t Fr o onst hea 2012 in, P rt dis ae ul, a ase nd a 1nd ,2M. 0d 0ia Chr beis te top s che a 2r ,4 e r 0 . Roe 0 Twb ouc -thir k. d 20 3 s ,13 a 1d 0. d 0e "H d ep arlt eh C -de 6a d ,2 ruc e 5 0 tSp ible ending cove r6 a a,ft g 0e e 5 r 0for Ad op bloo ting d1 p 2 6ar 0 , e 1 .Fu 1ss 0 %0 ll ur -Re e m pla onit cem or 1,e 0 s a nt 00nd , High- If this court decision is upheld, employers and health plans could impose some form of cost sharing for these Re t hesu Plt DsC ................................ for inhaled corticoste................................ roids, and an increase ................................ in adherence for statins ................................ . We are not surpris................................ ed by these findings. 11 m me ed etic tahe l se crrv itic er eia s in HSA for pre--e dligi edb uc let ible pla ns cov com erap ga er e tha d w t w ith non ere om -H itSA ted -e fr ligib omle N p ot la ic ns e . 20 Use 19 -of 45. lo For w-d e ens xait m yp lipop le, the rot n eot in (L ice D ide L) ntifies plans expa eligib ndele d he pre a-lt dh p educ lan, tible the c ov ma eg ra nit ge ude for of me the dic d at eions cline a s w nd aser s re vic lae tiv s t eha ly t sm praell a ves w nt te he ll. e Fu xarc the erb rm ator ion o e, tf c he 57 hr .im 9onic %plie d out-of- To estim 60% ate the impact of pre-deductible coverage on prescription 10% drug utili 57 za .7t % ion and adherence, a difference-in- Insulin and Other glucose-Lowering Agents 66% 10% Overall, the CCI currently consists of 17 health conditions. See Charlson et al. (1987); Deyo, Cherkin, and Ciol (1992); and insuli G In/ n es n g u d lu le in c rs ose-lowering agents, 61 percent added coverage 5for 5.3 % glucometers, and 54 percent added coverage for beta p Qua revn, e2013 nt Hiv ., D ee P ser d . uc Hv a tic ible lfon Sunda e 1s. Y ,2 H 5e 0 ea t, lth P em rap la ra loy n Wit ja 2n, e ,5 r0 s m A h a 0. Fong, a H y e ca ont lt B h Sa inu . 3,B 2ur e 5 v 0 ings Ac na to nd, prov J. cide oun C6 . ,tL 4 t he : ut 50 A se hi, L. D Fiser ve- vY ic . ee Sa a 6 s a r, unde 2 St t 5 udy." 0 no rs, C or E lo . Bw A RI 1 . c 2 B ost I,ss 5 e0 c ue k 0 to , T. E. Fe B m re iem f, bno. ea r 1s for sby , 0 38 0, 0 8 a and t leW ast . A a. 20 20 was the first full year that employers could have expanded pre-deductible coverage, and a 2020 survey from the 53.6% ACE testing, inhibit hem orog s tlob o pin A reve 1nt C (e H xa bA ce 1C rb)a tte ions sting, for a indiv nd reidua tinop lsa d thy iag nosed screenin wit g h conge increased stiv b ey he a a larrtg fa erilu preer c(e Cnt HF) ag, ed a ia m bong etes, a enr nd ol/or lee s pocket elasticities of de5 m 3.a 0nd % are closely aligned with previously published estimates. c dond ifferit eion nce ss (DiD (Fronst ) m in a odnd elin Fe g ndr appic roa k, c 20 h w 21a )s e . The mpim loyp ea dc. t Sp on ec pifi recm ally ium , for s of ea ec xpa h dnding epend p ernt e- d ve ad ria uc btle ible , a cm ov ult eriv aa gr eia fo ter r14 eg ression Discussion ............................................................................................................................................................ 13 N M ua m le b^ er of prescription 3% s 3% 70% 70% -80% 0.21 80% 34% 0.04 34% 62% 0.62% 25 60% 60% 29% 29% 68% 68% Quan et al. (2005) for more information. 0% 0% blocke 2014 rs. Hea Ghali. 200 lth ca 1,5. " 2 re 5 0 ser Cod vic ing es le Algo 2a ,5 st r 0 it 0 lik hm ely s for to ha D 3e v ,3 fin e0 p 0 ing re-C dom educ ort 6 b ible ,idit 55 0 ie cov s in I eraC ge D 6 -w 9 ,3 e -C 5 re 0 M pa end ak IfC low D 12 - 10 ,m 70 e A 0 te drm s ini rest larta etd 1iv , 0 te o 0 D 0 the ata ." few reasons (Em, pinc loyluding ee Be:ne fit Research Institute). Kaiser Family Foundation found that only 29 percent of employers with 200 or more employees increased the number c in HSA orona-re yligib artele ry p d la is ns ea c se. om P pa atrie ent d w s w ith th ho e ose ithe in r d he o a not lth p rela spo ns nd nott o taor rg e wtho ed h ba yv te his an pa olic dvy e rcsha e rnge eac, tion to AC suggesting E inh tha ibit t tor hes a IRS re services in HSA 50% -eligib 47.1% le health plans as allowed in IRS Notice 2019-45 is small (Fronstin, Roebuck, and Fendrick, 2022). was estF im em aa te led ^ with indica 97% tors for97% male, polic 30% yholder, 30% four age 20% group20% s, three g 66% eographi 66% c regions 38% , three ye 38% ars, HDHP 40%, 40% 71% 71% 32% 32% PropoD rte io dn u ct ofi bd le ays covered C (P oD pa C y) Coinsurance -0.01 Deductibl0 e.00 Copay 0C .0o1insurance Conclusion ........................................................................................................................................................... 16 tDis reatcu m 2015 ent ss of ion ast hm 1,3 a0 a 0nd interna 2,t6 iona 00 l normaliz 3,3 e5 d0 ratio (INR6), 6 te 5st 0ing for the 6,4 t5 r0 eatment of 12liv ,90 e0 r disea6 se a1 nd ,00b 0leeding 6 Medical Care 42 (11): 1130-9. Beta Blockers 54% of drugs and services covered pre-deductible in HSA-eligible health plans because of the 2 IRS noti 8.0% ce. 2020 was also the See Figure 13.14 in https://www.kff.org/report-section/ehbs-2020-section-13-employer-practices-alternative-sites-of-care- us cont uarlly ibut swit ed cthe o inc d tro ea ased ngio us tens e of in r the ece se ptser or v bic loc es. I kern a s (A dRB dits) ion, to us pre e v of ent sele the ct iv sa em ser e e ot xa onin r cerba etupta ionsk . e H inh owe ibit veor r, s (SSR ARBs a Is) re, not • AdThe heren la t c (P k D of C a = la 80r% ge ) increase in medication adherence0 m .00 ay also be 2 d5ue .7% to t 0he .02 fact that adherenc 0 2.e 5 0 . 6 4 r% a*** tes were Fu thrre the e H r D eH xpa P tnding imes y pera er- d int edeuc ratcible tion te covre m ra s, d ge etd o uc 11 tible 6 d, rug and cla Csha ses rlston hatC a om reor us be idit d m y ost Inde ly x. A ne for chrg onic ativ e d is be inom ase ia ml mod edicateion l was Fronst 1. in, P Em ap ul, a loye nd rs m M. aC y hr not ist op wahe ntr t Roe o cut b uc be kne . 20 fit20 s d . ur "Ma ing na ag ting im 2e 4.Use 4w %h eof n une Heam lth C ploy am ree Se nt ris vic low es A afnd ter rP ee cop ruit le m Sa ent tis a fy nd Their 2016 1,300 2,600 3,350 6,750 6,550 13,100 1,000 R dise or fe derre s nc (25e ps e rcent each). Most employers did not eliminate cost sharing for the pre-deductible services that were 24.8% As m Pe ont licio yh ne old d earbove, our39% findings ma 54% y be inf 71% luenced 73% by the w 73% ays in w 68% hich em 50% ployers im 61% plement 67% ed change 71% s in re 62% sponse66% 41% 51% 70% 72% a A fir nd pst p- e p yndix ro eavrid of ................................ er-tne hetw pa ond rkse /m . ic, and us ................................ e of health care serv................................ ices fell during that ye ................................ ar. ............................. 17 st inc alude tins, da 40% in t nd he angio listt e of ns14 in- c ser onv vic ee rts in N ing enzy oticm e e20 (A 1C 9E -45 ) inh , aibit nd o thus rs inc the rey a sed canno byt ab e la rcg ov ere p re ed rc p ernt e-adgeed uc am tible ong in HSA enrolle-e es in H ligibleSA - 25.8% managem alr ent ea d w yould rela taiv lseo lyha high, ve a asm vea ra ll im ging pa 77 ct p on erc pe re nt m tium o 89 s (pFr eronst centin, Roe , with th buc e k e, xc ae nd ption o Fendr f inha ick, 2022) led cor . E tic nr ost ollm ere oid nts, w into hich used for the number of prescriptions; ordinary least squares was used for the proportion of days covered; and probit Roe buck, DM. educ Chr tible istop : W he ha r. t 20 Do 12 C. op Thr ayem e eE nt ss s a aynd s on Coins the ur Ecaonc nom e Dic o? s of " EB Pr RI esc Iss ripti ueon BrD ierfugs. , no. D 51 is9 ser (E ta m tion, ploye Be a lt Bim ene orfit e, Re MD sea : rch retention of workers is of concern. Selective Serotonin Reuptake Inhibitors (SSRIs) added 2017 . The perce1 nt ,3a0g 0e eliminat2 ing ,60c 0ost sharing 3,4r0a0nged from 6 ,25 75 0 percent to 6,40 55 0 percent, d 1e 3p ,1 e0 n0 ding on the 1, 0 ser 00vice. The t Ao gr ta he w a IRS noti l, Rajende ce. r 2Fi , 2.Ole 4 r% st, nw a hil Ma e zur the e nk ovo, era all e nd m Np irloy Me ena r re che sponse mi. 20 to 17t. he "H not ighic -D e esee duc m tible ed ov He ea rw lth P helm lans ing Re , w dit uc h th e H re ee a- ltq h C uaratreer s he eligib alth p le p la la ns ns . Sim comila pa rr ly e, dser wit ot h th onin ose -nor ine he pine altph p hrine lans r enot upta ta kreg e inh teibit d bor y s (SNRI this polic s)y m cha aynge be , asu n e gff ge est cting ive t tr ha ea tt t m he ent IRS a for p lsa o tients 7 are often used as a rescue medication and not necessarily filled in a way that would suggest that an enrollee H wSA as -us eligib ed for le he ad ahe lth p ren la ce ns . The has b De iD en una estimff ae tor c Inthe s of ad le, d b C tut he ort ico een st ff r ee olle ro cit d se of s a pr re e -p da ey ding uctible a sm cov alle er r ash ge a raer e of gtiv he 43% en b totya l c the ost thr of eeser HD vic He Ps bays - References ........................................................................................................................................................... 18 See https://www.ebri.org/publications/research-publications/fast-facts/content/many-have-a-choice-of-health-plans-during- Deductible $3,907 $1,414 $3,641 $1,367 $3,698 $1,440 $3,771 $1,293 $3,682 $1,370 $3,609 $1,289 $3,828 $1,386 $3,732 $1,374 2. NuI E Univ m ns m be t pit r. loy u oof t f e e p) Ma rr.s m e scr rya la ip ytnd io bn es B lie av lte im tha ore t inc Count enty iv.izi ng the use of t0 he .0se 6 services reduce0 s. 0 a3 ggregate health sp 0e .0nding 8 in the We als 2018 o found no 1e ,3v5 ide 0 nce of c2 ha ,7nge 00 s in med 3ic ,4 a5 tion use 0 or 6a,d 90 h0 erence for6 a ,6 ny 50 of the me 1d 3,ic 3a 0t0 ions exam1 ine ,0d 00 in 2021, 2021 EBRI survey also found that most employers would add pre-deductible coverage for additional health care Cost And Utilization, Including Use Of Needed Preventive Services." Health Affairs 36 (10): 1762–1768. reporting that they expanded pre-deductible coverage for at least one of the 14 services, we would expect the largest 30% c wont ith d ribut epreedss tion w o incrho eased do not use r of espond these to prSSRI escripti s. on drugs. Use of health services may not have changed for all targeted was aIn dh he ar le ed nt C . orticosteroids for Asthma Antiresorptive Therapy for y cost ear sint ha Pe rr o ring p ao crttions ha ions sh o a f nd dift ays epdrco efr sent v om ere e d dd e ( P d in D uc C Fi t)ible gure s t 4o acs m opaayrm gina entl e s a ffe nd/or ct 0s .0c 0a coins lculaur teadnc ae t t(he Fronst m 0e .0 a in 1 n va and lue Volk s of ov a,ll oth 2023 e 0r .a 0 )r 1 . e gressors. open-enrollment. long term. Endno 2019 tes ................................ 1,350 2 ................................ ,700 3,500 ................................ 7,000 6,................................ 750 13,500 ............................. 1,000 21 a ser nd vic we es if a are llow not e su dr b py ris la ew d b (Fr y tonst he la in a ck nd of b Fe eha ndr vic ior k, c20 ha21 nge ). A in 2021 2021 A eH itI he P rsu . W rvhil eye of in p hera ior lth p wor lans k w aels found o found tha tha t tthr te hr ee -e- impact on doi:10.1 medica 37 tion a 7/hltdha heff r.2 enc 01 e7.06 for 1 d0. iab etes medications and beta blockers, as 66 percent and 54 percent added pre- Osteoporosis/Osteopenia servC ich eA a s a d rlh snd e orn e n ptr (eP sc Dr C ipti = on 80% d)rugs because many employers sub0 st .0 it1 uted copayments a 0.nd/or 01 coinsurance for 0.0 d 0eductibles. Fr Roe Stonst atb isuc tic in, P k a, l signifi M. aul, M Chrcis . atC nc op hr ehe is btr a op , sed J. heSa rupo Roe ma n st nt buc ha anda k , Da oug r nd d e he Ar. rror Ma tys c , rRob klus Fe tee nd rrte rK d ic a k b e. y st 20 ne pe 22 r r, son a . a"nd Pre rL e m a d u ium e ra not M. Im e d Mille p a ac st rfollow of . 20 Expa 15 s: *** . nding "Inc rp e < P arse 0.01 e-dD Use e ; d ** uc Of tpible <0.05 ; 8 3. There is precedent 2018 for cov 2021 ering these services without cost sharing in the absenc 3 e of the ACA mandate. When 2020 1,400 Angiotensin2 C ,8 on 0ve 0rting Enzym3 e ,(5 A5 C0 E) Inhibitors 7,100 6,900 13 39% ,800 1,000 quarters of employers said they added pre-deductible coverage as a result of the IRS notice in 2021 (Fronstin and q ua Alsro te sre s of e http hesa:lt //h p ahip lao ns rg -e pxp roa dnde uction. d psr3. e-adma edz uc ona tible ws .c cov om/ erd ao gce ume as a nts r/ e20210 sult of 9-tAH he IP IRS noti _HDHPc -S eurve . y.pdf and Furtherm 20% ore, there is already an appetite for adding more services, as evidenced by The Chronic Disease Management deduc Cotm ible or bciov dite yr age for those services, respectively. Less than one-half added pre-deductible coverage for inhaled Our Our fin ana dly ings ma sis confir y bm e s inf tha lue t nc me ed dic ba yt ion a the w da he ys in w rencehic imh e prov me pd loy am erong s im p ele nrm oll ee nt es us ed cing hange stas in r tins aend sponse insuli tno . tThi he s m IRS noti ay bec e. and * p