A recent study published in Health Affairs of a large employer's value-based insurance design (VBID) program showed how cutting copays for life-saving medications increases adherence. VBID supporters say the theory works: Affordable medicine increases adherence, improves outcomes, and may even save money in the long run through averted ER visits, hospitalizations, and decreased costs associated with chronic disease.
In the study, the employer reduced copays for five chronic medication classes within a disease management program: angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), beta-blockers, diabetes medications, HMG-CoA reductase inhibitors (statins), and inhaled cortiocosteroids (steroids). And these cuts were significant. The copayment rates for generic medications went from $5 to zero. Copays for brand-name drugs were lowered by 50 percent.
The results showed increased medication adherence in four of the five medication classes and reduced non-adherence by 7-14 percent.
VBIDs have grown in popularity since Pitney Bowes blazed the trail in 2002 by reducing copayments for several classes of prescription drugs. The Stamford, CT, company reported favorable clinical results, medication compliance, and cost savings. Since those first days of VBIDs, a growing number of employers, organizations, health plans, and academics have promoted VBIDs as a solution to medication compliance problems.
I am hosting an audio conference on the topic of VBIDs on March 13 with two of the leaders in the movement, A. Mark Fendrick, co-director of the University of Michigan's Center for Value-Based Insurance Design, and Gregory B. Steinberg, MD, chief medical officer at ActiveHealth Management in New York. Fendrick and Steinberg will provide information on VBIDs, and will highlight the study in Health Affairs.
They will also talk about how a more advanced VBID program could mean greater long-range savings. A tighter VBID option that offers different copays depending on health status goes beyond the more basic programs described earlier in this column. The more sophisticated design:
The tighter option needs a decision-support system to identify the right people and create an infrastructure that ties the pharmacy benefits manager to adjudicate and administer the program once the individuals are identified.
With an increasing number of studies showing the benefits of VBIDs, why have health plans been slow to join the party?
Here are three reasons:
There are lingering questions about actual savings, but the literature is pointing to its potential. What's needed now is for health plans and the greater healthcare system to fund further VBID research and programs to see if the theory's potential matches reality.