DEERFIELD, Ill., February 12, 2014
- Walgreens (NYSE:WAG) (Nasdaq:WAG) today presented research on how value-based insurance design (VBID) programs can be optimized by targeting the sickest, least adherent and most costly patients. These findings, presented at the 2014 PBMI Drug Benefit Conference in Las Vegas, examined how the VBID model can be most successful by reaching these targeted employee sub-populations.
VBID programs are emerging as a new benefit design focused on aligning patients' out-of-pocket costs, such as copayments and deductibles, with the value of health services. The model reduces barriers to high-value services such as preventive and chronic care therapies through lower costs to patients, while discouraging unproven, misused or low-benefit care through higher costs, ultimately improving health outcomes. Studies have shown that copayment reductions are often associated with improvements in medication adherence.
“As employers continue to look for innovative ways to manage health care costs while keeping employees healthy, VBID programs have emerged as a viable and effective solution,” said Bobby Clark, PhD, MSPharm and Walgreens director of clinical outcomes and reporting. “However, we have only just begun to look at whether these VBID programs are reaching the employees who can benefit the most from the programs. Our recent research provides new insight into how to successfully reach these sickest and most costly patients. We hope to see future studies further investigate how opt-in VBID programs can become more targeted and what the full cost, adherence and outcomes benefits will be when these programs are fully optimized.”
The Walgreens study, examined an employer-based VBID program implemented in January 2010, which eliminated the co-pay for generic anti-diabetic and anti-hyperlipidemic (cholesterol) medications. Eligible members (diabetic and/or high-cholesterol beneficiaries) were required to participate in a case management or wellness program to receive the zero co-pay benefit. The study findings include:
About 4,100 beneficiaries enrolled, while almost 22,000 elected not to; among those that enrolled, 3,400 had diabetes and high cholesterol, compared to 2,400 of the non-enrolled.
Both the enrolled diabetic and high cholesterol populations had higher adherence, the diabetic group’s adherence rate was 70 percent compared to about 45 percent for those not enrolled; the high cholesterol group’s adherence rate was about 66 percent vs. 55 percent for those not enrolled.
Dr. Clark discussed the research findings and the need for further research on whether opt-in VBID programs reach the sickest and least adherent enrollees at the 2014 PBMI Drug Benefit Conference. The presentation was the winner of the conference’s first poster competition, which required all participants to present their research to a panel of PBMI judges who evaluated them for emerging research and strategies of pharmacy benefit. The conference, held Feb. 3-5 in Las Vegas, gathered industry experts to share insights and strategies for the specialty and traditional pharmacy benefit.
In a related study by Dr. Clark and colleagues published in the Journal of Managed Care Pharmacy
, medication adherence and the costs for generic diabetes and cholesterol medications resulting from participation in a zero copay VBID program were examined. The zero copay program used a reduction in cost sharing to incentivize members to use more generic drugs and to enroll in a care management coaching program. The study also demonstrated that a value-based program can have a positive impact on adherence and cost outcomes among those who participate.1
J Manag Care Pharm. 2014;20(2): 141-50