Take Your Pills! Improving Medication Adherence through Value-Based Insurance Design Plans

Evidence suggests that failing to properly take doctor-prescribed pills costs Americans anywhere from $100-289 billion annually and, more importantly, is linked with 125,000 deaths in the US per year. To address this problem, a growing number of healthcare analysts are turning to a concept called Value-Based Insurance Design (VBID) plans, designed in part to increase medication adherence among patients. VBID plans, which are drawing increasing notoriety since the enactment of the Affordable Care Act (ACA), seek to use cost sharing measures to incentivize demonstrably effective medical treatments while deterring ineffective treatments through higher patient costs. In order to enhance VBID plans of the future, recent research by Choudhry et al. examines the relationship between the aforementioned tools used by VBID plans and their effect on patient medication adherence as one measure of improving patient health.

Since 2005, VBID plans have been implemented for public employees in states such as Connecticut and Oregon and are being examined more closely after the ACA’s implementation. VBID plans often offer tools and programs to improve patient health. The plans studied by Choudhry et al. used tools such as “generous” copay reductions, eliminating copay tiers, targeting higher risk patients, offering wellness programs, making benefits available solely for medication ordered by mail, and offering disease management programs. Because medication adherence is a key measure of greater patient accessibility to medically proven treatments, it is the focus of the researchers’ study.

The researchers studied 76 VBID plans operated by the pharmacy benefit manager CVS Caremark, offering a total sample size of nearly 275,000 VBID plan patients nationwide. Researchers then classified the plans based on six tools commonly employed by VBID plans (see graph below). A detailed categorization system was used to classify each plan, such as categorizing VBID plans as having “generous” copay reductions (when prices were lowered to $0 for generic drugs and $10 for brand-name drugs). For their analysis, the researchers separated patients into cohorts based on medical condition including diabetes, high cholesterol, and hypertension. The researchers then estimated medication adherence by collecting data on prescriptions filled by patients and dividing the daily doses of medicine obtained by the total number of days in the month. For instance, if a patient let ten days lapse before refilling her prescription, her adherence would be 21 days out of 31.

The researchers’ findings are presented in the chart above, demonstrating the relationship between six different features of VBID plans and their effect on medication adherence for three medical conditions. As the chart indicates, offering a disease management program is the only VBID plan characteristic studied that has a significant negative effect on medication adherence for each medical condition; four of the tools had strongly positive effects (all highly significant).

The researchers provide potential explanations for these findings. For example, the researchers conclude that the positive relationship between wellness programs and patient adherence exists due to increased patient engagement and awareness at site of the health benefits of medication adherence. Reduced copayments likely increase medication adherence by improving financial access to beneficial treatments so that patients don’t have to save up to refill their medications. On the other hand, disease management programs may be linked with a reduction of medication adherence because of the emphasis placed on alternative lifestyle behaviors rather than medication.

This study offers important information to aid healthcare leaders from both the public and private sectors to improve VBID plans by maximizing patient medication adherence. Even marginal increases in medication adherence can make a tangible impact on healthcare costs and patient health. Furthermore, health policy researchers should take note of the methodology used in this study and use the results and framework to carry out additional research that helps isolate the best practices associated with VBID plans. Though the potential gains of Value-Based Insurance Design plans are vast, these benefits cannot be translated into practical improvements in patient health outcomes without a commitment to further research seeking to identify characteristics associated with the optimal VBID plan.

Article Source: Niteesh K. Choudhry, Michael A. Fischer, Benjamin F. Smith, Gregory Brill, et al., “Five Features Of Value-Based Insurance Design Plans Were Associated With Higher Rates Of Medication Adherence,” Health Affairs 33 (Feb 2014).

Feature Photo: cc/(Alex Dodd)