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How to figure out the impact of HDHPs on patients

Written by Al Kenney on 19 June 2017. Posted in Co-Pay Program Optimization

HDHP Imact

All brands know that high deductible health plans are having a major impact on both the industry and on the costs of their individual copay programs.


I was recently told by a client that all brands are impacted the same way by these HDHP’s. While it may appear that way on the surface, every brand is impacted differently by HDHP’s.

Here are four things that will impact your brand when it comes to HDHP’s:

  1. Average age of your patient
  2. Chronic or Acute Condition
  3. Net cost of your drug
  4. Patient Comorbidities

While it looks like all brands are potentially looking at a similar landscape when it comes to the percent of their patients who are enrolled in HDHP’s, the four items above will certainly impact brands in different ways.

First, we have the average patient age. Brands targeting older patients will have more of their patient base on government insurance (Medicare and Medicaid) and therefore a lower percentage having to deal with the HDHP’s.

Brands treating acute conditions don’t have the luxury of providing higher subsidies via their copay program for the first few scripts until their patients meet their deductible. These are “1 or 2 uses and you’re done” drugs so the HDHP issue is certainly more of an issue for these acute medications.

After that it’s really just a numbers game. Drugs that have higher costs due to either high prices or poor managed care coverage will be impacted more by HDHP’s. Also, patients with comorbidities who take several medications will likely meet their deductible threshold faster. As these high deductible plans become more and more common, all of these things should be considered when planning your copay program and performing your copay program optimization analysis.