VBID Benefit Helps Patients Maintain Adherence After Switch to High-Deductible Plan

A study on the impact of a value-based pharmacy benefit on medication adherence found that offering free chronic disease medications maintained patients’ levels of adherence even after switching to a health plan with a deductible.

Previous research has indicated that value-based insurance design (VBID) can help drive medication adherence, but little is known about its effectiveness in conjunction with high-deductible health plans. Since switching to a plan with a deductible is likely to lower medication adherence due to the addition of out-of-pocket costs, researchers set out to determine if a value-based benefit could offset these anticipated reductions in adherence. Their findings were published in the most recent issue of Health Affairs.

The study identified 2482 patients within an integrated healthcare system who had a prescription for a diabetes, cholesterol, or hypertension drug. In 2014, when their employers switched to a high-deductible plan, 41% were enrolled in a plan with a VBID pharmacy benefit that provided free preventive chronic disease medication at no out-of-pocket cost to the beneficiary.

After the switch to the deductible plan, adherence among the patients without the VBID benefit dropped from 76.1% to 73.8%, while adherence remained steady among those with the VBID benefit. Adherence for patients in the VBID group with low adherence at baseline actually increased from 48.8% to 53.6% after the plan switch. There was no significant change in adherence after the switch between VBID and non-VBID patients who were already adherent at baseline.

However, the VBID intervention did not appear to impact adherence among certain subgroups. Adherence decreased at similar rates after the plan switch for both VBID and non-VBID patients living in neighborhoods of low socioeconomic status. There was also no significant differential change in adherence between the VBID and non-VBID beneficiaries with a high medication burden of 9 or more prescriptions at baseline. For patients with higher neighborhood socioeconomic status and those with lower medication burden, patterns were similar to the overall study population, as adherence decreased within the non-VBID groups and remained stable within the VBID groups.

The study authors pointed to their findings of better overall adherence with VBID as “consistent with findings from other types of VBID pharmacy benefits offering reduced-price medications.” However, they were surprise that the VBID benefit did not affect adherence among patients in lower socioeconomic status neighborhoods or with more complex drug regimens. They had initially predicted that it would in fact benefit these populations the most, as they incur greater out-of-pocket costs and likely experience more financial barriers to maintaining adherence.

Instead, the researchers suggested, low levels of medication adherence among these groups may be due to non-financial factors, like low health literacy or logistical barriers to access. They recommended additional efforts to educate vulnerable populations about the complexities of their health plan, and have begun a follow-up study that will attempt to increase engagement among these patients through the introduction of a targeted VBID benefit.

“As patient deductibles grow in both employer-sponsored and individually purchased health insurance plans, VBID provisions are a potential tool to use in offsetting financial barriers from deductibles and can help maintain low-cost access to high-value health care services and treatments,” the study authors concluded.