Three-fourth of large employers and health plans offering HSA-eligible plans have expanded pre-deductible coverage for medications and services that prevent the exacerbation of chronic conditions. This expansion, however, has had minimal impact on premiums, according to a new report from the Employee Benefit Research Institute.

"Our prior EBRI research demonstrated that a majority of employers would expand the list of services covered on a pre-deductible basis if allowed by the IRS," says Dr. A. Mark Fendrick, coauthor of the report and director of the University of Michigan Center for Value-Based Insurance Design. "Reflecting this interest, bipartisan, bicameral legislation has been introduced in the U.S. Congress that would provide additional flexibility to extend pre-deductible coverage to services that manage chronic conditions."

Among the key findings of the report:

• The premium impact was driven by the amount of increased uptake of drugs because of enhanced coverage; elimination of all consumer cost-sharing or inclusion of coinsurance in lieu of the deductible; and whether increased drug use led to offsets in spending on non-drug medical expenditures, such as preventable hospitalizations.
• Premiums increased the least (1.3%) when employers imposed coinsurance instead of a deductible; when increased use of prescription drugs led to reduced use of other medical services by 20%; and when utilization increased 12%.
• The most expensive scenario, an increase of 4.7%, occurred when increased prescription drug utilization led to no decrease in the use of other medical services; utilization increased 12%; and employers did not impose any coinsurance.

Overall health spending averaged $4,947 per person in 2018. Prescription drugs accounted for $983, or 20% of total spending. The 116 drug classes examined in this study accounted for $798, which was 81% of the drug spend and 16% of the total spend per person.