Five key features of popular value-based insurance design (VBID) plans are associated with the greatest impact on medication adherence, according to research by CVS Caremark Corp. and Brigham and Women's Hospital.


CVS Caremark, Brigham and Women's Hospital, value-based insurance design, VBID, VBID plans, medication adherence, pharmacy benefit structures, William Shrank, Niteesh Choudhry, medication use, out-of-pocket costs, health care spending, cost of prescription medications, Health Affairs and appear in the journal's March issue, Robert Wood Johnson Foundation, Changes in Health Care Financing and Organization Initiative






































































































































































































































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CVS research flags Rx benefit features encouraging adherence

February 13th, 2014

WOONSOCKET, R.I. – Five key features of popular value-based insurance design (VBID) plans are associated with the greatest impact on medication adherence, according to research by CVS Caremark Corp. and Brigham and Women's Hospital.

CVS said Thursday that the study, published online by Health Affairs and appear in the journal's March issue, was funded by a grant from the Robert Wood Johnson Foundation's Changes in Health Care Financing and Organization Initiative.

Pharmacy benefit structures such as co-payments, co-insurance and deductibles help payors mitigate health care spending by encouraging patients to consider and bear the cost of prescription medications. VBID plans instead reduce the cost to the patient for medications that offer a higher clinical benefit, under the rationale that increased medication use would improve health outcomes and lower overall health care spending.

For example, patients in a VBID plan who have a chronic disease such as high blood pressure may have their out-of-pocket costs, such as a co-pay, significantly reduced or eliminated for vital medications to treat their condition.

"VBID plans have been popular with employers and health plans as a way to use financial incentives and other methods to encourage medication adherence, improve health outcomes and reduce overall health care costs," study co-author William Shrank, senior vice president and chief scientific officer of CVS Caremark, said in a statement. "In order to optimize the benefits of VBID plans, these findings encourage more generous coverage for generics, greater use of 90-day prescriptions, more careful intervention targeting and expansion of wellness programs, all of which are active initiatives at CVS Caremark."

The researchers evaluated 76 VBID plans provided by CVS Caremark to 33 plan sponsors and involving more than 274,000 patients. Based on the analysis, five features were found to have a greater impact on adherence. They included more generous VBID plans (such as plans with no cost-sharing for generics and low monthly co-pays); plans that targeted high-risk patients; plans with concurrent wellness programs; plans without concurrent disease management programs; and plans that made the benefit available only by mail order, offering 90-day prescriptions.

"For the first time, this research offers high-quality, empirical data on the VBID plan features that appear most effective for stimulating greater medication adherence," stated study lead author Niteesh Choudhry, associate physician in the division of pharmacoepidemiology and pharmacoeconomics at Brigham and Women's Hospital and an associate professor at Harvard Medical School. "The results show that several specific features can improve adherence from between two to five percentage points, and this information can help influence how future co-payment reduction plans are structured for optimal benefit."

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