title: Prescription copay reduction program for diabetic employees: impact on medication compliance and healthcare costs and utilization.
abstract: OBJECTIVE
  To examine the impact of a value-based benefit design on utilization and expenditures.
  
  
  METHODS
  This benefit design involved all diabetes-related drugs and testing supplies placed on the lowest copay tier for 1 employer group. The sample of diabetic members were enrolled from a 9-month preperiod and for 2 years after the benefit design was implemented. Measured outcomes included prescription drug utilization for diabetes and medical utilization. Generalized measures were used to estimate differences between years 1 and 2 and the preperiod adjusting for age, gender, and comorbidity risk.
  
  
  RESULTS
  Diabetes prescription drug use increased by 9.5% in year 1 and by 5.5% in year 2, and mean adherence increased by 7% to 8% in year 1 and fell slightly in year 2 compared with the preperiod. Pharmacy expenditures increased by 47% and 53% and expenditures for diabetes services increased by 16% and 32% in years 1 and 2, respectively.
  
  
  CONCLUSIONS
  Increases in adherence and use of diabetes medications were observed. There were no compensatory cost-savings for the employer through lower utilization of medical expenditures in the first 2 years. Adherent patients had fewer emergency department visits than nonadherent patients after the implementation of this benefit design.
authors.affiliation: Associate Professor, School of Pharmacy, University of Colorado at Denver, Aurora, CO.
authors.forename: Kavita V
authors.initials: KV
authors.lastname: Nair
authors.affiliation: Vice President of Pharmacy Services, Great West Healthcare (now Cigna), Denver, CO.
authors.forename: Kerri
authors.initials: K
authors.lastname: Miller
authors.affiliation: Associate Professor, University of Colorado, Denver, CO.
authors.forename: Joseph
authors.initials: J
authors.lastname: Saseen
authors.affiliation: Statisticians, University of Colorado, Denver, CO.
authors.forename: Pamela
authors.initials: P
authors.lastname: Wolfe
authors.affiliation: Statisticians, University of Colorado, Denver, CO.
authors.forename: Richard Read
authors.initials: RR
authors.lastname: Allen
authors.affiliation: Pharmacy Manager, GlaxoSmithKline, Research Triangle Park, NC.
authors.forename: Jinhee
authors.initials: J
authors.lastname: Park