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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.

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Published Evidence for Value-Based Insurance Design

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  1. Published Evidence for Value-Based Insurance Design Michael C. Sokol, MD, MS Corporate Medical Director Merck & Co., Inc.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. 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.

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