Impact of a Combined Value-Based Insurance Design and Medication Therapy Management Program on Diabetes Medication...

Area of Science:

• Health Services Research
• Pharmacy Administration
• Health Economics

Background:

• Value-based insurance design (VBID) reduces copayments to lower cost barriers for prescription refills.
• Medication Therapy Management (MTM) is a clinical intervention to enhance patient understanding and address adherence barriers.
• Combined VBID and MTM programs have demonstrated increased adherence, but often lack control groups in studies.

Purpose of the Study:

• To evaluate the impact of a combined VBID and MTM program on medication adherence metrics.
• To assess these effects specifically in diabetic members of a large Midwest employer group.
• To analyze outcomes including proportion of days covered (PDC) and gaps in therapy (GIT).

Main Methods:

• Retrospective pre/post longitudinal analysis of pharmacy claims data.
• Comparison of 77 participants in a VBID/MTM program with 77 matched nonparticipants.
• Evaluation of oral antidiabetic medication adherence and costs over a 6-month period.

Main Results:

• The intervention group showed a nonsignificant increase in PDC (92.9% to 95.4%), while the control group decreased (92.8% to 91.7%).
• A significant PDC increase (84.7% to 93.1%) and GIT decrease (10.69 days) were observed in less adherent participants.
• Female participants experienced significant PDC increases and GIT decreases, unlike male participants.

Conclusions:

• The combined VBID/MTM program shows potential for influencing member adherence, particularly in lower-adherence subgroups.
• Statistically significant adherence improvements were not observed in the highly adherent baseline population.
• Larger, longer-term studies are recommended, potentially targeting cost savings from medical outcomes.