Transcript Published Evidence for Value-Based Insurance Design Michael C. Sokol, MD, MS Corporate Medical Director Merck & Co., Inc.

Published Evidence for
Value-Based Insurance Design
Michael C. Sokol, MD, MS
Corporate Medical Director
Merck & Co., Inc.
Higher Prescription Co-Pays Associated with
Lower Medication Adherence
Figure 4. Projected cumulative probability of medication termination over
the study period among patients with diabetes who differed in size of
baseline copayment but did not experience any change in copayment
1
0.9
Cumulative percent
0.8
0.7
$0
0.6
$1-15
0.5
$16-30
0.4
$31+
0.3
0.2
0.1
0
0
5
10
15
20
25
30
Number of months
Kessler RC, Cantrell CR, Berglund P, Sokol MC. The effects of co-payments on medication adherence during the first two
years of prescription drug treatment. Journal of Occupational and Environmental Medicine. 2007;49(6):597-609.
Relationship between Income and Medication
Adherence
Chernew M, Gibson TB, Yu-Isenberg K, Sokol MC, Rosen AB, Fendrick AM. Effects of Increased Patient Cost Sharing on Socioeconomic Disparities in
Health Care. Journal of General Internal Medicine. 2008;23(8):1131-1136.
Employer Example- Service Industry
 Purpose of study: Examine the impact of lowering Rx co-pays on
medication adherence
 5 drug classes studied: ACE/ARBs, beta blockers, diabetes
medications, statins, inhaled steroids
 Prospective, pre/post study with control group
 Time period: 2004 (pre) and 2005 (post)
 Both intervention and control groups used same disease
management programs
Chernew ME, Shah M, Wegh A, Rosenberg S, Juster IA, Rosen AB, Sokol MC, Yu-Isenberg K, Fendrick AM. Impact of
Prescription Co-payments on Medication Adherence in the Context of a Disease Management Program. Health Affairs.
2008;27(1):103-112.
Lower Prescription Co-Pays Associated with Higher
Medication Adherence
Chernew ME, Shah M, Wegh A, Rosenberg S, Juster IA, Rosen AB, Sokol MC, Yu-Isenberg K, Fendrick AM. Impact of
Prescription Co-payments on Medication Adherence in the Context of a Disease Management Program. Health Affairs.
2008;27(1):103-112.
Financial Outcomes of Intervention
 Program led to reduced use of nondrug health care
services, offsetting costs associated with additional
use of drugs encouraged by the program
 Thus, the intervention broke even (or even saved
money)
 A targeted intervention, focusing on high-risk
patients, would be even more favorable
 “Indirect” savings, such as productivity gains, could
further offset the additional drug spending
Chernew ME, Shah M, Wegh A, Rosenberg S, Juster IA, Rosen AB, Sokol MC, Yu-Isenberg K, Fendrick AM.
Evidence that Value-Based Insurance Can Be Effective. Health Affairs. Web Exclusive Jan 2010.
Employer Example- City of Asheville, NC
 Purpose of study: To assess the persistence of outcomes for up to 5
years following the initiation of community-based pharmaceutical
care services for patients with diabetes
 Education by certified diabetes educators, pharmacist follow-up using
scheduled consultations, clinical assessment, goal setting,
monitoring, and collaborative drug therapy management with
physicians.
 Diabetes prescription co-pays and diabetic supplies waived for
program participation
 Longitudinal pre−post cohort study
 Time period: 1997-2001
Cranor CW, Bunting BA, Christensen DB. The Asheville Project: Long-term clinical and economic outcomes of a community
pharmacy diabetes care program. J Am Pharm Assoc. 2003;43:173-84.
Higher Medication Adherence Associated with
Lower Total Health Care Costs
Cranor CW, Bunting BA, Christensen DB. The Asheville Project: Long-term clinical and economic outcomes of a community
pharmacy diabetes care program. J Am Pharm Assoc. 2003;43:173-84.
Employer Example- Large Manufacturer
 Purpose of study: Examine the impact of medication adherence on
hospitalization risk and health care cost
 4 disease states studied- diabetes, high blood pressure, high
cholesterol, heart failure
 Retrospective, observational study
 Time period: 1997-1999
 Diabetes
– 3,260 patients in cohort
– Average age was 54 years old
– 45% female
Sokol MC, McGuigan KA, Verbrugge RR, Epstein RS. Impact of medication adherence on hospitalization risk and healthcare
cost. Medical Care. 2005;43:521-530.
Higher Medication Adherence Associated with Lower
Total Health Care Costs
Diabetes Costs
per patient per year ($)
Average expenditures
10000
9000
P< 0.05
$55
8000
$165
7000
$285
$404
Rx $
6000
$763
5000
Medical $
4000
3000
$8,812
$6,959
$6,237
$5,887
$3,808
1-19%
20-39%
40-59%
60-79%
80-100%
2000
1000
0
Adherence level (% Days supply / 1 year)
Sokol MC, McGuigan KA, Verbrugge RR, Epstein RS. Impact of medication adherence on hospitalization risk and healthcare
cost. Medical Care. 2005;43:521-530.
Higher Medication Adherence Associated
with Lower Hospitalization Rate
Diabetes Hospitalization Risk
35
Risk (%)
30
25
30*
20
26*
25*
20*
15
10
13
5
0
1-19
20-39
40-59
60-79
80-100
Adherence level (%)
*Indicates that outcome is significantly higher than outcome for 80-100% adherence group (P<0.05). Differences were tested for
medical cost and hospitalization risk.
Sokol MC, McGuigan KA, Verbrugge RR, Epstein RS. Impact of medication adherence on hospitalization risk and healthcare cost. Medical Care.
2005;43:521-530.