Value-Based Insurance Design Improves Patient Medication Adherence

Ensuring patients adhere to a medication schedule is a constant challenge for healthcare providers as many factors – such as cost, convenience and side effects – influence whether a patient takes their pills as prescribed. Multiple studies have found that patients are less likely to consistently take their medication if their out-of-pocket cost for those prescriptions is higher; some patients will take their medications at less frequent intervals to make them last longer, while others will avoid refilling their prescriptions at all.

To address this issue, some payers have introduced plans founded on value-based insurance design (VBID) which offer lower prices for medicines which could have the greatest benefit for patients. Depending on how much of a benefit the drug is likely to have, the payer may also choose to offer some for no out-of-pocket cost.

A new study published in the journal Health Affairs sought to determine whether these VBID plans had the desired effect on patient medication adherence. The researchers found that patients covered under these plans were more likely to fill their prescriptions more often. Interestingly, while the cost of covering a drug under this type of plan in higher for payers, the overall cost of insuring a given patient did not increase, suggesting that patients who take their medication more faithfully tend to need fewer additional healthcare services.

“Enhanced access to high-value drugs that did not lead to an increase in total spending is a win/win for both insurers and patients,” said Director of the University of Michigan Center for Value Based Insurance Design, Dr. Mark Fendrick, senior author of the new review and one of the originators of the VBID concept in the early 2000s. “If total costs are equal, using more medicines that prevent costly hospitalizations is clearly preferable to having people being admitted to a hospital.”

Fendrick and his colleagues reviewed 21 studies conducted in the last decade which compared traditional health insurance plans with the VBID prescription drug plans. Specifically, they analyzed how low copays for medications which treat chronic conditions – including diabetes, hypertension, hyperlipidemia and asthma – affected a patient’s medication adherence.

They assessed how faithful patients were to their medication schedule by looking at the duration of a prescription and comparing it to the amount of medication they had actually picked up from the pharmacy. In order to determine what effect the VBID plans had on payers, the research team also analyzed healthcare spending, clinical outcomes and whether patients made use of other healthcare services covered by their insurers.

In terms of diabetes patients, the researchers found that all studies showed an increase in drug adherence when patients were covered under a VBID plan. The do, however, admit that some patients were offered the chance to participate in a disease management program which may also have contributed to higher adherence rates.

All studies of statin use showed improved medication adherence among VBID-covered patients with high cholesterol, and the majority of studies of hypertension medication showed the same. Of the five studies which examined medication use in asthma patients, two showed that the value-based plans helped patients adhere to medications.

In three of the nine studies which analyzed the cost of these plans, patients were found to have significantly lower out-of-pocket costs compared to those on conventional insurance plans. In most studies, insurers were found to pay more for medications however, they also showed that decreased spending on other healthcare services helped payers to offset this cost.

While the US healthcare system still has a long way to go before the problem of patient non-adherence to medications is under control, the VBID-type insurance plans seem to be making headway. The challenge now lies in providing more patients with access to these healthcare plans, particularly those with chronic conditions which require long-term disease management.