title: The effect of a large regional health plan's value-based insurance design program on statin use.
abstract: BACKGROUND
  Cost-sharing requirements employed by health insurers to discourage the unnecessary use of medications may lead to underutilization of recommended treatment regimens and suboptimal quality of care. Value-based insurance design (VBID) programs seek to address these problems by lowering copayments to promote adherence to "high-value" medications that have been proven to be clinically beneficial. VBID evaluations to date have focused on programs implemented by self-insured employers. This study is among the first to assess the VBID program of a health plan.
  
  
  METHODS
  We examined a VBID program for statins implemented by a large regional health plan in 2008 and assessed its effect on medication adherence. Copayments on VBID brand statins were reduced by 42.9% for employer-sponsored plans (the treatment group) and increased by 16.7% for state-sponsored plans (the control group) between the preintervention and postintervention periods. Propensity score weights were used to balance the treatment and control groups on observed characteristics. We evaluated the impact of the VBID program on adherence using an econometric model with a difference-in-difference design.
  
  
  RESULTS
  Medication adherence increased 2.7 percentage points (P=0.033) among VBID brand statin users in the treatment group relative to the control group. With a baseline adherence rate of 77.6%, nonadherence was reduced by 11.9%.
  
  
  CONCLUSIONS
  Copayment reductions on selected statin medications contributed to improvements in adherence. As one of the first studies to evaluate a health plan's VBID program, our findings demonstrate that insurer-based VBID programs may yield results similar to those achieved by employer-based programs.
authors.affiliation: Interfaculty Initiative in Health Policy, Graduate School of Arts and Sciences, Harvard University, 14 Story St, Cambridge, MA 02138, USA. frank2@fas.harvard.edu
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Frank
authors.forename: A Mark
authors.initials: AM
authors.lastname: Fendrick
authors.forename: Yulei
authors.initials: Y
authors.lastname: He
authors.forename: Arthur
authors.initials: A
authors.lastname: Zbrozek
authors.forename: Norma
authors.initials: N
authors.lastname: Holtz
authors.forename: Simon
authors.initials: S
authors.lastname: Leung
authors.forename: Michael E
authors.initials: ME
authors.lastname: Chernew
mesh_terms: D017047:Cost Sharing / Q000191:economics* / Q000379:methods*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage* / Q000191:economics*; D007343:Insurance Carriers / Q000191:economics*; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D014481:United States; D016903:Drug Monitoring
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors