Researchers from University of Washington Provide Details of New Studies and Findings in the Area of Managed Care and Specialty Pharmacy (Drug Use and Spending Under a Formulary Informed By Cost-effectiveness): Drugs and Therapies – Managed Care and Specialty Pharmacy

2024 FEB 02 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- A new study on Drugs and Therapies - Managed Care and Specialty Pharmacy is now available. According to news reporting originating from Seattle, Washington, by NewsRx correspondents, research stated, “The National Academy of Medicine has called for value-based drug formularies to address health plan prescription drug spending while maintaining access to high-value medicines. Thirty employer -sponsored plans implemented a ‘Value-Based Formulary-essentials’ (VBF-e) program that uses cost-effectiveness evidence to inform cost-sharing and coverage exclusion.To evaluate if the VBF-e was associated with changes in medication use and patient out-of-pocket spending and health plan spending on prescription drugs and other health care.”

Financial support for this research came from Patrick and Catherine Weldon Donaghue Medical Research Foundation’s Greater Value Portfolio Program.

Our news editors obtained a quote from the research from the University of Washington, “This was a cohort study using a difference-in-differences design from 2015 through 2019 with 1 year of follow-up after VBF-e implementation at Premera Blue Cross, the largest nonprofit health plan in the Pacific Northwest. The VBF-e exposure group was composed of all individuals aged younger than 65 years and enrolled at least 12 months prior to their employer group’s VBF-e implementation date. The contemporaneous control group was composed of propensity score-matched individuals with the same inclusion criteria but their employer group that did not implement VBF-e. We prespecified the following outcomes: days of medication on hand overall and by VBF-e tier (high-value generic, brand, and specialty drugs were in tiers 1 to 3, respectively, and low-value drugs were in tier 4 or excluded from coverage); prescription drug spending; and other health care use (emergency department visits, hospital days, and outpatient visits). Comparing 12,111 exposed (mean age = 36.0; 49.8% female sex) participants with 24,222 control participants (mean age = 34.7; 49.6% female sex), VBF-e reduced use of low-value drugs by 0.3 days per member per month (PMPM) (95% CI = -0.5 to -0.1; 17% decrease) for tier 4 drugs and 0.4 days PMPM (95% CI = -0.5 to -0.4; 83% decrease) for excluded drugs. High-value specialty drug use increased by 0.1 days PMPM (95% CI = 0.0-0.1; 123% increase). Health plan spending decreased by $14 PMPM (95% CI = -26 to -4) and member out-of-pocket spending increased by $1 PMPM (95% CI = 1-2).”

According to the news editors, the research concluded: “Other health care use did not change significantly.An exclusion formulary informed by cost-effectiveness evidence reduced low-value drug use, increased high value specialty drug use, reduced health plan spending, and increased member outof-pocket spending without increasing acute care use.Study Registration Number: NCT04904055.”

This research has been peer-reviewed.

For more information on this research see: Drug Use and Spending Under a Formulary Informed By Cost-effectiveness. Journal of Managed Care & Specialty Pharmacy, 2023;29(11):1175-1183. Journal of Managed Care & Specialty Pharmacy can be contacted at: Acad Managed Care Pharmacy, 100 N Pitt St, 400, Alexandria, VA 22314-3134, USA.

The news editors report that additional information may be obtained by contacting Kai Yeung, University of Washington, School of Pharmacy, Comparat Hlth Outcomes Policy & Econ Choice Inst, Seattle, WA 98195, United States. Additional authors for this research include John B. Watkins, Sean D. Sullivan, Maricela Cruz and Emily Tsiao.

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