Value-Based Insurance Improves Cost-Related Patient Adherence Issues

Study suggests that covering high-value medications benefits patients at no extra cost to insurers.

Poor medication adherence resulting from missed doses, delayed prescription refills, or the lack of any refills is often associated with the cost of a prescription. It has previously been found that the more a patient pays out-of-pocket for a prescription, the less likely that patient is to be adherent.

Targeting cost with a value-based insurance design (VBID) may be the solution to cost-related adherence issues, according to a study published by Health Affairs. Insurance plans that operate by charging patients less for the most beneficial medicines, and potentially making some medicine free to patients with certain conditions, can be an effective method, according to the study authors.

The VBID plans were shown to improve adherence among patients without increasing the cost of insuring a patient. Although drug costs grew for insurers, the total price of insurance remained the same, which suggests that improved adherence results in less spending on other health care, according to the study.

"Enhanced access to high-value drugs that did not lead to an increase in total spending is a win/win for both insurers and patients," Mark Fendrick, MD, senior author, said in a press release. "If total costs are equal, using more medicines that prevent costly hospitalizations is clearly preferable to having people being admitted to a hospital."

The authors thoroughly examined 21 studies from the past 10 years assessing VBID prescription drug plans compared with standard plans. Each study was measured to a high standard based on the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system.

Insurance plans with VBID-style co-pays and co-insurance were reviewed in comparison with standard plans. Out-of-pocket payments were reduced in the VBID-style plans for prescriptions that are considered high-value to patients with certain conditions. Drugs used for long-term prevention in high-risk patients, including patients with diabetes, high blood pressure, high cholesterol, and asthma, were prioritized in the study, according to the researchers.

Related Coverage: Adherence Lacking to High-Cost Multiple Sclerosis Disease-Modifying Drugs

The authors measured the impact of reduced out-of-pocket costs on adherence by comparing the amount of medication obtained to the length of the prescription, according to the study. The authors also took health care spending, use of health care services, clinical outcomes, and quality of care from the studies into account.

With a VBID model, patients who used diabetes medications had a significant improvement in patient adherence. The authors noted, however, that diabetes management programs may be partially responsible for the drastic increase.

Most of the studies on blood pressure medication and all of the studies on cholesterol-lowering statins showed an improvement in adherence with a VBID plan, according to the study. Only 2 of the 5 studies on asthma medication adherence with a VBID plan showed improvement.

The authors looked at 9 studies on overall health care spending for patients with a VBID plan, most of which showed an increase in spending on prescription drugs for insurers, while 3 studies showed a significant decrease in out-of-pocket costs for patients.

The studies suggest that the increase in drug spending was offset by decreased spending in other areas of health care, such as hospital visits, the researchers noted. Insurers experienced a reduced cost for patients with a VBID-style plan in 2 cases, while the other 7 cases showed no change in cost for insurers, according to the study.

The assessment did not provide any substantial evidence on patient outcomes or quality of care from a VBID-style plan. The authors noted that future studies need to focus on examining the long-term patient outcomes associated with a VBID-style plan.


Agarwal R, Gupta A, Fendrick AM. Value-based insurance design improves medication adherence without an increase in total health care spending. Health Affairs. 2018.

Pay Less, Take More: Success in Getting Patients to Take Their Medicine [news release]. University of Michigan’s website. Accessed July 11, 2018.