The value of value-based insurance design: savings from eliminating drug co-payments

Am J Manag Care. 2016 Feb;22(2):116-21.

Abstract

Objectives: To estimate the cost impact of a $0 co-pay prescription drug program implemented by a large healthcare employer as a part of its employee wellness program.

Study design: A $0 co-pay program that included approximately 200 antihypertensive, antidiabetic, and antilipid medications was offered to Geisinger Health System (GHS) employees covered by Geisinger Health Plan (GHP) in 2007. Claims data from GHP for the years 2005 to 2011 were obtained. The sample was restricted to continuously enrolled members with Geisinger primary care providers throughout the study period.

Methods: The intervention group, defined as 2251 GHS employees receiving any of the drugs eligible for $0 co-pay, was propensity score matched based on 2 years of pre-intervention claims data to a comparison group, which was defined as 3857 non-GHS employees receiving the same eligible drugs at the same time. Generalized linear models were used to estimate differences in terms of per-member-per-month (PMPM) claims amounts related to prescription drugs and medical care.

Results: Total healthcare spending (medical plus prescription drug spending) among the GHS employees was lower by $144 PMPM (13%; 95% CI, $38-$250) during the months when they were taking any of the eligible drugs. Considering the drug acquisition cost and the forgone co-pay, the estimated return on investment over a 5-year period was 1.8.

Conclusions: This finding suggests that VBID implementation within the context of a wider employee wellness program targeting the appropriate population can potentially lead to positive cost savings.

MeSH terms

  • Age Factors
  • Antihypertensive Agents / economics
  • Comorbidity
  • Deductibles and Coinsurance / economics*
  • Humans
  • Hypoglycemic Agents / economics
  • Hypolipidemic Agents / economics
  • Insurance Claim Review / statistics & numerical data
  • Prescription Drugs / economics*
  • Sex Factors
  • Value-Based Health Insurance / economics*

Substances

  • Antihypertensive Agents
  • Hypoglycemic Agents
  • Hypolipidemic Agents
  • Prescription Drugs