Opioid Use Disorder Care Presentations After High-deductible Health Plan Enrollment

Objective: Determine whether employer-mandated transitions from low- to high-deductible health plans (HDHPs) are associated with delays in opioid use disorder (OUD)-related care presentations. Cost-sharing may negatively impact timely diagnosis and treatment of OUD. Methods: Using 2003–2017 national commercial insurance claims data, we used a matched time-to-event and difference-in-differences design to examine the association between employer-mandated transitions from low to HDHPs on OUD-related care presentations. Study group included 574,058 adults aged 18–64 years continuously enrolled in low-deductible (<$500) health plans during a baseline year followed by up to 4 years in HDHPs (≥$1000) after an employer-mandated transition (exposure). Control group included 4,386,636 adults contemporaneously enrolled in low-deductible plans matched on employee and employer characteristics. Outcomes included first OUD-related office visit, buprenorphine pharmacy fill, and OUD-related high-acuity visit. The secondary outcome was the yearly number of high-acuity care days. Results: After an employer-mandated HDHP transition, there were no differences in time-to-first OUD-related office visit (HR, 1.02, 95% CI: 0.94, 1.11) or buprenorphine fill (HR, 1.05, 95% CI: 0.97–1.13) in the HDHP versus control cohort. In contrast, the HDHP transition was associated with delays in time-to-first OUD-related high-acuity visits compared with control members (HR 0.86, 95% CI: 0.79–0.93). HDHP members experienced a 37.4% (95% CI: −57.8, −17.0) relative reduction in high-acuity care days relative to the control group from baseline to follow-up. Conclusions: Employer-mandated transitions to HDHPs were associated with delays and reductions in OUD-related high-acuity presentations. Such delays and reductions in timely OUD care could lead to adverse health outcomes.