New research from Walgreen Co. sheds light on how value-based insurance design (VBID) programs can be optimized by targeting the sickest, least adherent and most costly patients.

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Walgreens: Targeted employer Rx programs aid adherence

February 12th, 2014

DEERFIELD, Ill. – New research from Walgreen Co. sheds light on how value-based insurance design (VBID) programs can be optimized by targeting the sickest, least adherent and most costly patients.

Walgreens said Wednesday that the findings, presented at the 2014 PBMI Drug Benefit Conference in Las Vegas, demonstrate how targeted employer prescription programs improve medication adherence and rein in costs.

According to Walgreens, VBID programs are emerging as a new benefit design focused on aligning patients' out-of-pocket costs, such as co-payments and deductibles, with the value of health services. The model reduces barriers to high-value services such as preventive and chronic care therapies through lower costs to patients, while discouraging unproven, misused or low-benefit care through higher costs — in turn, improving health outcomes.

Studies have shown that copayment reductions are often associated with improvements in medication adherence, the drug chain noted.

"As employers continue to look for innovative ways to manage health care costs while keeping employees healthy, VBID programs have emerged as a viable and effective solution," Bobby Clark,  director of clinical outcomes and reporting at Walgreens, said in a statement. "However, we have only just begun to look at whether these VBID programs are reaching the employees who can benefit the most from the programs. Our recent research provides new insight into how to successfully reach these sickest and most costly patients. We hope to see future studies further investigate how opt-in VBID programs can become more targeted and what the full cost, adherence and outcomes benefits will be when these programs are fully optimized."

The Walgreens study examined an employer-based VBID program implemented in January 2010 that eliminated the co-pay for generic anti-diabetic and anti-hyperlipidemic (cholesterol) medications. Eligible members (diabetic and/or high-cholesterol beneficiaries) were required to participate in a case management or wellness program to receive the zero co-pay benefit.

About 4,100 beneficiaries enrolled, and almost 22,000 elected not to do so. Among those that enrolled, 3,400 had diabetes and high cholesterol, compared with 2,400 of those who didn't enroll.

Both the enrolled diabetic and high-cholesterol populations had higher medication adherence, with the diabetic group's adherence rate at 70% versus about 45% for the non-enrolles. The high-cholesterol group's adherence rate was about 66%, compared with 55% for those not enrolled.

In a related study by Clark and colleagues that was published in the Journal of Managed Care Pharmacy, medication adherence and the costs for generic diabetes and cholesterol medications resulting from participation in a zero co-pay VBID program were examined. The zero co-pay program used a reduction in cost sharing to incentivize members to use more generic drugs and to enroll in a care management coaching program. The study also demonstrated that a value-based program can have a positive impact on adherence and cost outcomes among those who participate.