Value-Based Insurance Design Improves Adherence to Diabetes Drugs


Better medication adherence may not result in lower short-term medical costs for patients with diabetes.

Prime Therapeutics recently released a report that found that while value-based insurance design (VBID) improves adherence to diabetes drugs, it may not save money in the short-term, according to a press release.

Many manufacturers and payers show growing interest in VBID as a way to drive quality and reduce the cost of care by reducing unnecessary tests and services performed to increase reimbursement.

The CDC estimates that more than 29 million Americans have diabetes. Since diabetes drives 20% of healthcare spending, payers and healthcare stakeholders have searched for viable ways to control costs.

In the first half of 2017, Prime reports that diabetes was the non-specialty drug category driving commercial drug spending, accounting for more than 13% of costs, according to the release. This represented an increase in spend of more than 4% increase from 2016 to 2017.

The pharmacy benefit manager (PBM) implemented VBID for diabetes drugs in an effort to reduce costs. The approach lowered the co-payment for insulin from $30 for a 30-day supply to $15, while also allowing patients to pick up a 100-day supply, according to Prime.

Additionally, Prime allowed patients to pick up a 100-day supply for $15 for generics or $30 for preferred formulary drugs, according to the release.

An analysis of integrated pharmacy and medical data showed that there was no difference in total cost of care between patients with a VBID and those with standard benefits, according to the report. These findings remained true after adjusting for confounding factors, including cost differences.

“These types of value-based arrangements are one spoke in the wheel of controlling costs,” said Patrick Gleason, PharmD, senior director of health outcomes at Prime. “Despite the rhetoric in the marketplace about these types of contracts being a silver bullet, our study indicates they have a long way to go.”

Although VBID did not lower total cost of care, the analysis indicates that it may improve medication adherence among patients with diabetes.

Under the VBID, there was a 1.2% higher rate of patients receiving diabetes treatment, including a 12% increased use of insulin, according to the report.

Compared with patients who had standard benefits, those with VBID had a 1.5% increased rate of adherence.

Prime noted that the growing use of diabetes drugs increased drug spending by 27%, which offset the potential cost savings the drugs may provide in the future, according to the release.

“While this VBID for diabetes drugs appeared to improve the quality of diabetes drug use, we didn’t see lower total cost of care, potentially due to the many years it takes to see medical event avoidance with improved diabetes drug use and the escalating diabetes drug costs,” Gleason said. “In a drug category such as diabetes, where drug costs are growing at an unsustainable rate, Prime continues to work with health plans to assess both medical and pharmacy data and develop solutions to help curb the trend. It is our hope that better adherence to medicine leads to better outcomes and lower total cost of care.”

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