title: Simulated value-based insurance design applied to statin use by Medicare beneficiaries with diabetes.
abstract: OBJECTIVE
  To examine cost responsiveness and total costs associated with a simulated "value-based" insurance design for statin therapy in a Medicare population with diabetes.
  
  
  METHODS
  Four-year panels were constructed from the 1997-2005 Medicare Current Beneficiary Survey selected by self-report or claims-based diagnoses of diabetes in year 1 and use of statins in year 2 (N = 899). We computed the number of 30-day statin prescription fills, out-of-pocket and third-party drug costs, and Medicare Part A and Part B spending. Multivariate ordinary least squares regression models predicted statin fills as a function of out-of-pocket costs, and a generalized linear model with log link predicted Medicare spending as a function of number of fills, controlling for baseline characteristics. Estimated coefficients were used to simulate changes in fills associated with co-payment caps from $25 to $1 and to compute changes in third-party payments and Medicare cost offsets associated with incremental fills. Analyses were stratified by patient cardiovascular event risk.
  
  
  RESULTS
  A simulated out-of-pocket price of $25 [$1] increased plan drug spending by $340 [$794] and generated Medicare Part A/B savings of $262 [$531]; savings for high-risk patients were $558 [$1193], generating a net saving of $249 [$415].
  
  
  CONCLUSIONS
  Reducing statin co-payments for Medicare beneficiaries with diabetes resulted in modestly increased use and reduced medical spending. The value-based insurance design simulation strategy met financial feasibility criteria but only for higher-risk patients.
authors.affiliation: Pharmaceutical Health Services Research,Department School of Pharmacy, University of Maryland Baltimore, Baltimore, MD 21201, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Davidoff
authors.forename: Ruth
authors.initials: R
authors.lastname: Lopert
authors.forename: Bruce
authors.initials: B
authors.lastname: Stuart
authors.forename: Thomas
authors.initials: T
authors.lastname: Shaffer
authors.forename: Jennifer T
authors.initials: JT
authors.lastname: Lloyd
authors.forename: J Samantha
authors.initials: JS
authors.lastname: Shoemaker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000517:prevention & control; D003922:Diabetes Mellitus, Type 1; D003924:Diabetes Mellitus, Type 2; D005260:Female; D005382:Financing, Personal / Q000191:economics; D019538:Health Care Surveys; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics* / Q000627:therapeutic use; D019458:Insurance Coverage / Q000458:organization & administration*; D007348:Insurance, Health; D008297:Male; D006278:Medicare / Q000191:economics*; D008875:Middle Aged; D010349:Patient Compliance; D016730:Program Development; D011787:Quality of Health Care; D012044:Regression Analysis; D014481:United States
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors