High-Deductible Health Plan Enrollment and Buprenorphine Dispensing.

Importance: Buprenorphine can prevent opioid overdose deaths among patients with opioid use disorder (OUD). Among privately insured patients using buprenorphine, it is unclear whether switching from a non-high-deductible health plan (HDHP) to an HDHP is associated with changes in buprenorphine dispensing or OUD-related health care visits. Objective: To evaluate the association between switching to an HDHP, buprenorphine dispensing, and OUD-related health care visits. Design, Setting, and Participants: Repeated cross-sectional difference-in-differences analysis of the 2010 to 2023 Optum Labs Data Warehouse, a longitudinal clinical database with deidentified claims. Analyses included privately insured adults who were continuously enrolled throughout a baseline and follow-up year and had buprenorphine dispensing in the baseline year. The treatment group included patients who switched from a non-HDHP to an HDHP. The control group included patients who remained in a non-HDHP. Data were analyzed from January 1, 2025, through February 1, 2026. Exposure: Switching to an HDHP. Main Outcomes and Measures: Annual number of days with active buprenorphine prescriptions; annual number of OUD-related outpatient visits; annual number of OUD-related emergency department visits or hospitalizations. Linear models with patient fixed effects compared changes in outcomes among the treatment and control groups. In a subgroup analysis, the treatment group was limited to patients experiencing a deductible increase exceeding the median of $1250. Results: Among 14 801 included patients (9419 [63.6%] male), switching to an HDHP was associated with a differential decrease in the number of days with active buprenorphine prescriptions (-29.0; 95% CI, -35.0 to -22.9) but not with changes in OUD-related outpatient visits (-0.5; 95% CI, -1.0 to 0.05) or OUD-related emergency department visits and hospitalizations (4.0 events per 100 patients; 95% CI, -0.5 to 8.4 events per 100 patients). In the subgroup analysis, switching to an HDHP was associated with a differential decrease in the number of OUD-related outpatient visits (-1.0; 95% CI, -1.8 to -0.3). Results for other outcomes were similar to the overall analysis. Conclusions and Relevance: In this repeated cross-sectional study using difference-in-differences analysis of privately insured patients using buprenorphine, those who switched to an HDHP were more likely to decrease buprenorphine use. When deductible increases were large, patients who switched to an HDHP were also more likely to decrease the number of OUD-related outpatient visits. Findings suggest that switching to an HDHP may be associated with heightened barriers to OUD treatment.