Value-Based Insurance Design Drives Medication Adherence

As a significant component of health reform, Value-Based based Insurance Design (V-BID) promotes innovative health benefit designs that improve health outcomes in a cost-effective way. By setting patients’ cost-sharing amounts in relation to the value that a treatment offers (ie, lower costs for higher-value treatments), V-BID plans to reduce the barriers that keep patients from receiving high-value treatments. Now a study supporting those notions finds that 5 features of V-BID plans are associated with having the greatest impact on patients’ medication adherence.

"For the first time, this research offers high-quality, empirical data on the V-BID plan features that appear most effective for stimulating greater medication adherence," said Niteesh Choudhry, MD, PhD, associate physician, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, and associate professor, Harvard Medical School, and the lead author of the study. "The results show that several specific features can improve adherence from between 2 to 5 percentage points, and this information can help influence how future co-payment reduction plans are structured for optimal benefit."

The study, conducted by researchers from CVS Caremark and Brigham and Women's Hospital, evaluated 76 V-BID plans involving 33 different plan sponsors and nearly a quarter of a million patients. They found that a variety of V-BID benefit structures can provide significant improvements in patients’ long-term adherence. Reasons were that plans were more generous, targeted high-risk patients, had wellness programs, did not have disease management programs, and made the benefit available only for medication ordered by mail.

“These results were consistent across the disease states we studied. Given the wide variation in how VBID plan designs have been implemented across the United States, these results may be used to influence how future plans are structured,” the authors wrote.

The research findings will be useful for pharmacists and policy makers alike as they consider how to improve medication adherence as well as the management of chronic conditions like diabetes through health plan benefit design. Jan Berger, MD, MJ, editor-in-chief of The American Journal of Pharmacy Benefits, recently noted that V-BID plans are important because they support a consumer-focused model of health insurance.

“The 1 challenge that I continue to hear mentioned by those organizations that are utilizing these benefit tools is that consumers are not utilizing these tools to the degree the organizations would like them to,” she said. “Although we still struggle with utilization of the tools that exist today, we need to continue to evolve into a more consumer-focused world.”

Around the Web

CVS Caremark Research Identifies Optimal Elements of Effective Value-Based Insurance Design (VBID) Plans [PR Newswire]

Five Features Of Value-Based Insurance Design Plans Were Associated With Higher Rates Of Medication Adherence [Health Affairs]