Out-of-pocket drug, medical costs may explain lower satisfaction with HDHPs

Dive Brief:

Privately-insured U.S. adults enrolled in a traditional healthcare plan are slightly more satisfied with their plans than those enrolled in a high-deductible health plan (HDHP), according to a survey published in December by the Employee Benefit Research Institute (EBRI) and Greenwald & Associates.
Out-of-pocket costs may account for differences in overall plan satisfaction, according to a summary of the results. HDHP-enrolled individuals in the 2,068-person survey were less likely than those enrolled in traditional plans to say they were "extremely" or "very" satisfied with the costs they paid out of pocket for prescriptions drugs and other healthcare needs. But those enrolled in HDHPs were also more likely than traditional plan enrollees to exhibit "cost-conscious" behaviors like asking for a generic drug instead of a brand name.
Across all respondents, plan design satisfaction tended to increase the longer an individual had been enrolled in their plan, EBRI and Greenwald & Associates said. For example, 35% of those enrolled in an HDHP for less than one year reported high satisfaction with their plan, compared to 50% of those enrolled in an HDHP for three or more years.

Dive Insight:

Respondents to the annual poll by EBRI and Greenwald & Associates have consistently indicated high satisfaction with their health plants. But in 2018, results indicated that respondents felt less favorably about the U.S. healthcare system and were concerned about their ability to pay for future treatments.

Large employers may be shifting strategies in response to employee demand for more plan design choice. A survey last year by the National Business Group on Health (NBGH) found 11% of large employers that planned to offer an optional consumer-directed health plan (CDHP) in 2020 were previously on track to offer a CDHP as their only health plan. Per NBGH, employers are opting to do so in order to maintain more predictable health costs and be sensitive to employees with chronic health conditions, among other reasons.

The EBRI/Greenwald & Associates survey showed privately-insured adults, particularly those enrolled in HDHPs, are concerned about drug costs. This concern is shared by many employers as drug costs, particularly for specialty drugs, continue to rise. Brian Marcotte, the outgoing president and CEO of NBGH, told HR Dive in a December interview that drug pricing "has the potential to crush" employer payers.

Marcotte and others have previously pointed to changes in the pharmaceutical supply chain and to pharmacy benefit managers that could improve costs, but more work remains. One employer-based pharmacy benefit purchasing coalition found in 2018 that fewer than 1% of prescriptions accounted for 40% of its total drug costs.