Impact of State Telehealth Parity Laws for Private Payers on Hypertension Management before and during the COVID-19 Pandemic

Donglan Zhang, Jun Soo Lee, Adebola Popoola, Sarah Lee, Sandra L. Jackson, Lisa M Pollack, Xiaobei Dong, Feijun Luo, Nicole Leigh Therrien
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Abstract

BACKGROUND: Telehealth has emerged as an effective tool for managing common chronic conditions such as hypertension, especially during the COVID-19 pandemic. However, the impact of state telehealth payment and coverage parity laws on hypertension management remains uncertain. METHODS: Data from the MerativeTM MarketScan(R) Commercial Claims and Encounters Database from January 1, 2016 to December 31, 2021 were used to construct the study cohort. The sample included non-pregnant individuals aged 25?64 years with hypertension. We reviewed and coded telehealth parity laws related to hypertension management in all 50 states and the District of Columbia, distinguishing between payment parity laws and coverage parity laws. The primary outcomes were antihypertension medication use, measured by the average medication possession ratio (MPR), medication adherence (MPR ?80%), and average number of days of drug supply. We used a generalized difference-in-difference (DID) design to examine the impact of these laws. Results were presented as marginal effects and 95% confidence intervals (CI). RESULTS: Among 353,220 individuals, states with payment parity laws were significantly linked to increased average MPR by 0.43 percentage point (95% CI: 0.07 - 0.79), and an increase of 0.46 percentage point (95% CI: 0.06 - 0.92) in the probability of medication adherence. Payment parity laws also led to an average increase of 2.14 days (95% CI: 0.11 - 4.17) in antihypertensive drug supply, after controlling for state-fixed effects, year-fixed effects, individual sociodemographic characteristics and state time-varying covariates including unemployment rates, GDP per capita, and poverty rates. In contrast, coverage parity laws were associated with a 2.13-day increase (95% CI: 0.19 - 4.07) in days of drug supply, but did not significantly increase the average MPR or probability of medication adherence. In addition, telehealth payment or coverage parity laws were positively associated with the number of hypertension-related telehealth visits, but this effect did not reach statistical significance. These findings were consistent in sensitivity analyses. CONCLUSIONS: State telehealth payment parity laws were significantly associated with greater medication adherence, whereas coverage parity laws were not. With the increasing adoption of telehealth parity laws across states, these findings may support policymakers in understanding potential implications on management of hypertension.
针对私人支付者的国家远程医疗平价法在COVID-19大流行之前和期间对高血压管理的影响
背景:远程医疗已成为管理高血压等常见慢性病的有效工具,特别是在2019冠状病毒病大流行期间。然而,国家远程医疗支付和覆盖均等法对高血压管理的影响仍然不确定。方法:使用2016年1月1日至2021年12月31日MerativeTM MarketScan®商业索赔和遭遇数据库中的数据构建研究队列。样本包括年龄在25?64年高血压。我们审查并编码了所有50个州和哥伦比亚特区与高血压管理相关的远程医疗平价法,区分了支付平价法和覆盖平价法。主要结局是抗高血压药物的使用,以平均药物持有率(MPR)、药物依从性(MPR - 80%)和平均药物供应天数来衡量。我们使用广义差中差(DID)设计来检验这些规律的影响。结果以边际效应和95%置信区间(CI)表示。结果:在353,220个人中,有支付平价法的州与平均MPR增加0.43个百分点(95% CI: 0.07 - 0.79)显著相关,药物依从性概率增加0.46个百分点(95% CI: 0.06 - 0.92)。在控制了国家固定效应、年度固定效应、个体社会人口学特征和国家时变共变量(包括失业率、人均GDP和贫困率)后,支付平价法还导致抗高血压药物供应平均增加2.14天(95% CI: 0.11 - 4.17)。相比之下,覆盖平价法律与药物供应天数增加2.13天(95% CI: 0.19 - 4.07)相关,但没有显著增加平均MPR或药物依从性的可能性。此外,远程医疗支付或覆盖平价法律与高血压相关的远程医疗就诊次数呈正相关,但这种影响没有达到统计学意义。这些发现在敏感性分析中是一致的。结论:州远程医疗支付平价法与更大的药物依从性显著相关,而覆盖平价法则不相关。随着各州越来越多地采用远程医疗平等法,这些发现可能支持决策者了解高血压管理的潜在影响。
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