Analysis of a Value-Based Insurance Design Program

Las Vegas—A retrospective cross-sectional study found that a value-based insurance design program reached the sickest and most costly patients, but it did not attract individuals who were most nonadherent to medications.

Only a small percentage of patients with diabetes and/or hyperlipidemia who were eligible to enroll in the program ended up enrolling, so many of the people who could benefit were not able to take advantage of the program’s benefits.

These results were presented during a poster session at the PBMI conference. The poster was titled Are Value-Based Insurance Design Programs Reaching the Targeted Sub-Populations?

The authors noted that employers use value-based insurance design to control costs. They attempt to increase costs for lower value services, decrease costs for higher value services, and encourage the use of higher value medical services.

In this study, the authors were interested in identifying beneficiaries choosing to enroll in employer-sponsored value-based insurance design programs and evaluating if people who enrolled were the ones who could benefit the most from the program.

The value-based insurance design program was implemented in January 2010 and removed the copayment for generic antidiabetic and antihyperlipidemic medications. Members of the program were eligible if they had diabetes or hyperlipidemia. To receive the zero-copay benefit, they were required to participate in a case management or wellness program.

The authors obtained de-identified medication dispensing data from the employers’ enterprise data warehouse, which included 2 years of prescription fills dispensed. They determined patient characteristics during the 12-month baseline period before enrollment.

Of the 26,068 beneficiaries eligible for the value-based insurance design program, 4087 (15.7%) chose to enroll. Of the people who enrolled, 83.1% had diabetes and hyperlipidemia, while 10.7% of people who chose not to enroll had both chronic conditions. The average age of the enrollees was 54.3 years, 53.9% were male, 10.1% had diabetes only, and 6.8% had hyperlipidemia only.

Of the people who enrolled in the program and had diabetes, 69.7% had high adherence, which was defined as taking the medications at least 85% of the days covered.

Meanwhile, 44.7% of the patients with diabetes who did not enroll had high adherence. Furthermore, patients with diabetes who enrolled in the program had an average of 4 comorbidities compared with an average of 1.5 comorbidities among individuals who did not enroll. The enrolled group had a per-member, per-year pharmacy cost of $3387 compared with $2232 for patients who did not enroll (P<.001).

Of the patients with hyperlipidemia, 66.4% of patients who enrolled in the program had high adherence compared with 54.6% of people who did not enroll (P<.0001). In addition, the average number of comorbidities was 4.1 and 2.9, respectively (P=.0001), while the average per-member, per-year medication cost was $3413 and $1977, respectively (P<.0001).

The generic dispensing rate was 68.8% for patients with diabetes who enrolled in the program and 67.1% for patients with diabetes who did not enroll (P=.0008). The generic dispensing rate was 68.8% for patients with diabetes who enrolled in the program and 67.1% for patients with diabetes who did not enroll (P=.0008). In addition, the generic dispensing rate was 69.5% for patients with hyperlipidemia who enrolled in the program and 67.1% for patients with hyperlipidemia who did not enroll (P<.0001).

This research was funded by Walgreens Co.