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Published Evidence for Value-Based Insurance Design. Michael C. Sokol, MD, MS Corporate Medical Director Merck & Co., Inc. Higher Prescription Co-Pays Associated with Lower Medication Adherence.

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published evidence for value based insurance design

Published Evidence for Value-Based Insurance Design

Michael C. Sokol, MD, MS

Corporate Medical Director

Merck & Co., Inc.

higher prescription co pays associated with lower medication adherence
Higher Prescription Co-Pays Associated with Lower Medication Adherence

Kessler RC, Cantrell CR, Berglund P, Sokol MC. The effects of co-payments on medication adherence during the first two years of prescription drug treatment. Journal of Occupational and Environmental Medicine. 2007;49(6):597-609.

relationship between income and medication adherence
Relationship between Income and Medication Adherence

Chernew M, Gibson TB, Yu-Isenberg K, Sokol MC, Rosen AB, Fendrick AM. Effects of Increased Patient Cost Sharing on Socioeconomic Disparities in Health Care. Journal of General Internal Medicine. 2008;23(8):1131-1136.

employer example service industry
Employer Example- Service Industry
  • Purpose of study: Examine the impact of lowering Rx co-pays on medication adherence
  • 5 drug classes studied: ACE/ARBs, beta blockers, diabetes medications, statins, inhaled steroids
  • Prospective, pre/post study with control group
  • Time period: 2004 (pre) and 2005 (post)
  • Both intervention and control groups used same disease management programs

Chernew ME, Shah M, Wegh A, Rosenberg S, Juster IA, Rosen AB, Sokol MC, Yu-Isenberg K, Fendrick AM. Impact of Prescription Co-payments on Medication Adherence in the Context of a Disease Management Program. Health Affairs. 2008;27(1):103-112.

lower prescription co pays associated with higher medication adherence
Lower Prescription Co-Pays Associated with Higher Medication Adherence

Chernew ME, Shah M, Wegh A, Rosenberg S, Juster IA, Rosen AB, Sokol MC, Yu-Isenberg K, Fendrick AM. Impact of Prescription Co-payments on Medication Adherence in the Context of a Disease Management Program. Health Affairs. 2008;27(1):103-112.

financial outcomes of intervention
Financial Outcomes of Intervention
  • Program led to reduced use of nondrug health care services, offsetting costs associated with additional use of drugs encouraged by the program
  • Thus, the intervention broke even (or even saved money)
  • A targeted intervention, focusing on high-risk patients, would be even more favorable
  • “Indirect” savings, such as productivity gains, could further offset the additional drug spending

Chernew ME, Shah M, Wegh A, Rosenberg S, Juster IA, Rosen AB, Sokol MC, Yu-Isenberg K, Fendrick AM. Evidence that Value-Based Insurance Can Be Effective. Health Affairs. Web Exclusive Jan 2010.

employer example city of asheville nc
Employer Example- City of Asheville, NC
  • Purpose of study: To assess the persistence of outcomes for up to 5 years following the initiation of community-based pharmaceutical care services for patients with diabetes
  • Education by certified diabetes educators, pharmacist follow-up using scheduled consultations, clinical assessment, goal setting, monitoring, and collaborative drug therapy management with physicians.
  • Diabetes prescription co-pays and diabetic supplies waived for program participation
  • Longitudinal pre−post cohort study
  • Time period: 1997-2001

Cranor CW, Bunting BA, Christensen DB. The Asheville Project: Long-term clinical and economic outcomes of a community pharmacy diabetes care program. J Am Pharm Assoc. 2003;43:173-84.

higher medication adherence associated with lower total health care costs
Higher Medication Adherence Associated with Lower Total Health Care Costs

Cranor CW, Bunting BA, Christensen DB. The Asheville Project: Long-term clinical and economic outcomes of a community pharmacy diabetes care program. J Am Pharm Assoc. 2003;43:173-84.

employer example large manufacturer
Employer Example- Large Manufacturer
  • Purpose of study: Examine the impact of medication adherence on hospitalization risk and health care cost
  • 4 disease states studied- diabetes, high blood pressure, high cholesterol, heart failure
  • Retrospective, observational study
  • Time period: 1997-1999
  • Diabetes
    • 3,260 patients in cohort
    • Average age was 54 years old
    • 45% female

Sokol MC, McGuigan KA, Verbrugge RR, Epstein RS. Impact of medication adherence on hospitalization risk and healthcare cost. Medical Care. 2005;43:521-530.

higher medication adherence associated with lower total health care costs10
Higher Medication Adherence Associated with Lower Total Health Care Costs

Diabetes Costs

10000

P< 0.05

$55

9000

8000

$165

$285

7000

$404

Rx $

Average expenditures

per patient per year ($)

6000

Medical $

$763

5000

4000

$6,959

$6,237

$8,812

$5,887

$3,808

3000

2000

1000

0

1-19%

20-39%

40-59%

60-79%

80-100%

Adherence level (% Days supply/1 year)

Sokol MC, McGuigan KA, Verbrugge RR, Epstein RS. Impact of medication adherence on hospitalization risk and healthcare cost. Medical Care. 2005;43:521-530.

higher medication adherence associated with lower hospitalization rate
Higher Medication Adherence Associated with Lower Hospitalization Rate

Diabetes Hospitalization Risk

35

30

30*

25

Risk (%)

26*

25*

20

20*

15

10

13

5

0

40-59

60-79

1-19

20-39

80-100

Adherence level (%)

*Indicates that outcome is significantly higher than outcome for 80-100% adherence group (P<0.05). Differences were tested for medical cost and hospitalization risk.

Sokol MC, McGuigan KA, Verbrugge RR, Epstein RS. Impact of medication adherence on hospitalization risk and healthcare cost. Medical Care. 2005;43:521-530.