Researchers’ Work from University of Washington Focuses on Managed Care (Impact of a Value-based Formulary on Medication Utilization, Health Services…

Researchers' Work from University of Washington Focuses on Managed Care (Impact of a Value-based Formulary on Medication Utilization, Health Services Utilization, and Expenditures)

By a News Reporter-Staff News Editor at Insurance Weekly News -- Current study results on Managed Care have been published. According to news reporting originating from Seattle, Washington, by VerticalNews correspondents, research stated, "Value-based benefit design has been suggested as an effective approach to managing the high cost of pharmaceuticals in health insurance markets. Premera Blue Cross, a large regional health plan, implemented a value-based formulary (VBF) for pharmaceuticals in 2010 that explicitly used cost-effectiveness analysis (CEA) to inform medication copayments."

Our news editors obtained a quote from the research from the University of Washington, "Objective of the Study: The objective of the study was to determine the impact of the VBF. Interrupted time series of employer-sponsored plans from 2006 to 2013. Intervention group: 5235 beneficiaries exposed to the VBF. Control group: 11,171 beneficiaries in plans without any changes in pharmacy benefits. The VBF-assigned medications with lower value (estimated by CEA) to higher copayment tiers and assigned medications with higher value to lower copayment tiers. Primary outcome was medication expenditures from member, health plan, and member plus health plan perspectives. Secondary outcomes were medication utilization, emergency department visits, hospitalizations, office visits, and nonmedication expenditures. In the intervention group after VBF implementation, member medication expenditures increased by $2 per member per month (PMPM) [95% confidence interval (CI), $1-$3] or 9%, whereas health plan medication expenditures decreased by $10 PMPM (CI, $18-$2) or 16%, resulting in a net decrease of $8 PMPM (CI, $15-$2) or 10%, which translates to a net savings of $1.1 million. Utilization of medications moved into lower copayment tiers increased by 1.95 days' supply (CI, 1.29-2.62) or 17%. Total medication utilization, health services utilization, and nonmedication expenditures did not change."

According to the news editors, the research concluded: "Cost-sharing informed by CEA reduced overall medication expenditures without negatively impacting medication utilization, health services utilization, or nonmedication expenditures."

For more information on this research see: Impact of a Value-based Formulary on Medication Utilization, Health Services Utilization, and Expenditures. Medical Care, 2017;55(2):191-198. Medical Care can be contacted at: Lippincott Williams & Wilkins, Two Commerce Sq, 2001 Market St, Philadelphia, PA 19103, USA. (Lippincott Williams and Wilkins - www.lww.com; Medical Care - journals.lww.com/lww-medicalcare/pages/default.aspx)

The news editors report that additional information may be obtained by contacting K. Yeung, University of Washington, Pharmaceut Outcomes Res & Policy Program, Seattle, WA 98195, United States. Additional authors for this research include A. Basu, R.N. Hansen, J.B. Watkins and S.D. Sullivan.

Keywords for this news article include: Seattle, Washington, United States, North and Central America, Managed Care, University of Washington.

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