How do incentive-based formularies influence drug selection and spending for hypertension?

Area of Science:

• Health Economics
• Pharmacoeconomics
• Clinical Pharmacy

Background:

• Formularies significantly impact prescription drug selection and healthcare spending.
• Understanding the effects of different formulary designs, particularly incentive-based ones, is crucial for cost-effective medication management.

Purpose of the Study:

• To investigate the association between incentive-based formularies and the selection and spending of antihypertensive medications.
• To compare the impact of single-tier versus multi-tier formulary systems with varying copayment differentials on drug utilization.

Main Methods:

• Comparative analysis of antihypertensive drug use across five drug classes.
• Evaluation based on formulary tier structure and copayment differences.
• Assessment of the impact of incentive formularies on plan spending and enrollee out-of-pocket costs.

Main Results:

• Raising copayments in single-tier formularies had a limited effect on antihypertensive use compared to multi-tier systems.
• Two-tier plans with a $10 generic/brand copayment differential reduced the likelihood of using ACE inhibitors and angiotensin II receptor blockers.
• Incentive formularies led to lower overall antihypertensive spending by health plans, but increased out-of-pocket costs for enrollees.

Conclusions:

• Formulary design, especially multi-tier systems with copayment incentives, can influence antihypertensive drug selection.
• While incentive formularies may reduce overall plan costs, they can shift the financial burden to patients.
• Further research is needed to balance cost containment with patient access and affordability.