Impact Of Decreasing Copayments On Medication Adherence Within A Disease Management Environment

Abstract

This paper estimates the effects of a large employer's value-based insurance initiative designed to improve adherence to recommended treatment regimens. The intervention reduced copayments for five chronic medication classes in the context of a disease management (DM) program. Compared to a control employer that used the same DM program, adherence to medications in the value-based intervention increased for four of five medication classes, reducing nonadherence by 7-14 percent. The results demonstrate the potential for copayment reductions for highly valued services to increase medication adherence above the effects of existing DM programs.

Trends in Patient Cost Sharing for Clinical Services Used as Quality Indicators

“…11,12 A controlled evaluation of a VBID intervention demonstrated significant increases in patient compliance. 13 As a result, momentum has spread to the public sector; VBID programs have been put into action by several state governments, and Congressional legislation was introduced in Congress (S.1040) to apply VBID principles in Medicare Part D. 14 Benefit designers should consider reversing the trend of copayment increases for services considered to be indicators of high quality care. Moreover, payers desiring to optimize health gains per dollar spent should avoid "across the board" cost sharing, and instead implement a "value based" design that removes barriers/provides incentives to encourage desired behaviors for patients and providers.…”

Confronting Hysteria: A Reply to Fairman and Curtiss

“…Our editorial directly quoted Chernew et al's original research article and the press release put forth by the University of Michigan, which houses the Center for Value-Based Insurance Design. 1,2,6 These quotations included Chernew et al's statements that "…we expect health improvements, although we do not quantify them in this study," and that because of the intervention, "there might be gains in worker productivity or reduced absenteeism or disability." 2 As we noted in our editorial, Chernew et al's report provided neither citations to published research nor study findings to support these statements.…”

“…2 More broadly, they take issue with the concept of VBID itself. Given the tone, we felt compelled to reply, yet disagree with only a few points of their critique.…”

“…As the authors note, and as we explicitly state in the Health Affairs article, 2 we do not assess the financial effects of the intervention-a separate manuscript addressing expenditures is in progress. The closest we come to claiming anything about the financial effects is noting that preliminary analysis suggests the savings in nondrug services could offset the financial costs of increased use.…”

Policy Implications of Oral Agents

“…For example, difficulty with affording medications 4 and the amount of the co-payment are directly associated with medication adherence. 5 In some diseases, such as diabetes and hypercholesterolemia, a high level of medication adherence is directly associated with lower disease-related healthcare costs. 6 However, a gap exists in the literature, with little known about the influence of economic factors, such as prescription benefits, co-payments or out-of-pocket cost, and adherence to oral antineoplastic agents.…”