Impact of High Deductible Health Plans on US Adults With Chronic Pain

Introduction: Chronic pain affects an estimated 20% of U.S. adults. Because high-deductible health plans have captured a growing share of the commercial insurance market, it is unknown how high -deductible health plans impact care for chronic pain. Methods: Using 2007-2017 claims data from a large national commercial insurer, statistical anal-yses conducted in 2022-2023 estimated changes in enrollee outcomes before and after their firm began offering a high-deductible health plan compared with changes in outcomes in a comparison group of enrollees at firms never offering a high-deductible health plan. The sample included 757,530 commercially insured adults aged 18-64 years with headache, low back pain, arthritis, neu-ropathic pain, or fibromyalgia. Outcomes, measured at the enrollee year level, included the proba-bility of receiving any chronic pain treatment, nonpharmacologic pain treatment, and opioid and nonopioid prescriptions; the number of nonpharmacologic pain treatment days; number and days' supply of opioid and nonopioid prescriptions; and total annual spending and out-of-pocket spending. Results: High-deductible health plan offer was associated with a 1.2 percentage point reduction (95% CI= -1.8, -0.5) in the probability of any chronic pain treatment and an $11 increase (95% CI=$6, $15) in annual out-of-pocket spending on chronic pain treatments among those with any use, representing a 16% increase in average annual out-of-pocket spending over the pre -high deductible health plan offer annual average. Results were driven by changes in nonpharmacologic treatment use. Conclusions: By reducing the use of nonpharmacologic chronic pain treatments and marginally increasing out-of-pocket costs among those using these services, high-deductible health plans may discourage more holistic, integrated approaches to caring for patients with chronic pain conditions. Am J Prev Med 2023;65(5):800-808. (c) 2023 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.