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Am J Manag Care. 2020 Feb;26(2):75-79. doi: 10.37765/ajmc.2020.42396.

Preventive drug lists as tools for managing asthma medication costs.

Author information

1
Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Campus Box 7440, Chapel Hill, NC 27599. Email: gilkey@email.unc.edu.

Abstract

OBJECTIVES:

Preventive drug lists (PDLs) are a value-based insurance design intended to help high-deductible health plan (HDHP) members by covering preventive medications at lower or no cost before deductibles are met. Because little is known about members' experiences using this new tool, we sought to evaluate benefits and challenges of using PDLs to manage asthma costs.

STUDY DESIGN:

Qualitative interview study.

METHODS:

In 2018, we conducted telephone interviews with US adults (n = 22) who (1) were in HDHPs with PDLs and (2) had asthma and/or a child with asthma. We analyzed data using thematic content analysis.

RESULTS:

Some members reported that PDLs provided financial benefit and facilitated adherence to preventive medications. Others experienced barriers to using PDLs. Notably, some PDLs did not include members' asthma medications or provided only modest cost coverage due to restrictions in underlying formulary structures. Members who were aware of having a PDL sometimes worked with their providers to switch to listed medications. However, many members were not aware of having a PDL. Finally, because PDLs did not cover nonmedication costs, some members still struggled to afford asthma care.

CONCLUSIONS:

PDLs are a promising tool for helping families in HDHPs manage their medication costs and, in turn, their asthma. However, given current limitations in coverage, members must be aware of the benefit to seek out listed medications, and they may still struggle with the remaining cost sharing. Attention to implementation, including member outreach and education, is likely needed to realize the full potential of PDLs.

PMID:
32059095
DOI:
10.37765/ajmc.2020.42396
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