Medication adherence changes following value-based insurance design.
To determine whether participation in a value-based insurance design (VBID) program was associated with improved medication adherence in 8 drug classes 2 years after implementation and to examine whether adherence changes varied by baseline adherence.



We used a pre-post quasi-experimental study design with a retrospective cohort of 74,748 enrollees using 8 different therapeutic classes of medications to treat diabetes, hypertension, hyperlipidemia, or congestive heart failure.



Brand-name medication copayments were lowered (from tier 3 to tier 2) for all enrollees, while generic copayments were waived only for employers who opted into the VBID program. Medication adherence of VBID program participants and nonparticipants 12 months before and 12 and 24 months after program implementation were estimated on 8 propensity-matched cohorts using generalized estimating equations, as well as on subgroups stratified by baseline adherence. Adherence was measured using the medication possession ratio (MPR) from medication refill records.



VBID was associated with improved medication adherence ranging from 1.4% to 3.2% at 1 year, which increased to 2.1% to 5.2% 2 years following VBID adoption. Adherence changes were most notable among patients who were nonadherent (MPR <.50) before VBID implementation.



Population-based implementation of VBID can improve adherence to medications to treat cardiometabolic conditions, particularly for previously nonadherent patients. VBID guidelines being developed in response to healthcare reform should account for the heterogeneity in patient response to VBID programs.
Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599-7360, USA. jffarley@unc.edu
Joel F
JF
Farley
Daryl
D
Wansink
Jennifer H
JH
Lindquist
John C
JC
Parker
Matthew L
ML
Maciejewski
D002908:Chronic Disease; D017048:Health Care Costs; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data*; D009657:North Carolina; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors; D016903:Drug Monitoring