Open AccessDesign, Implementation, and First-Year Outcomes of a Value-Based Drug Formulary
Author(s) -
Sean D. Sullivan,
Kai Yeung,
Carol Vogeler,
Scott D. Ramsey,
Edward S. Wong,
Chad O. Murphy,
Dan Danielson,
David L. Veenstra,
Louis P. Garrison,
Wylie Burke,
John B. Watkins
Publication year - 2015
Publication title -
journal of managed care and specialty pharmacy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.126
H-Index - 63
eISSN - 2376-1032
pISSN - 2376-0540
DOI - 10.18553/jmcp.2015.21.4.269
Subject(s) - copayment , formulary , pharmacy , medicine , actuarial science , implementation , medicaid , cost sharing , business , health care , family medicine , health insurance , economics , computer science , nursing , programming language , economic growth
Value-based insurance design attempts to align drug copayment tier with value rather than cost. Previous implementations of value-based insurance design have lowered copayments for drugs indicated for select "high value" conditions and have found modest improvements in medication adherence. However, these implementations have generally not resulted in cost savings to the health plan, suggesting a need for increased copayments for "low value" drugs. Further, previous implementations have assigned equal copayment reductions to all drugs within a therapeutic area without assessing the value of individual drugs. Aligning the individual drug's copayment to its specific value may yield greater clinical and economic benefits. In 2010, Premera Blue Cross, a large not-for-profit health plan in the Pacific Northwest, implemented a value-based drug formulary (VBF) that explicitly uses cost-effectiveness analyses after safety and efficacy reviews to estimate the value of each individual drug. Concurrently, Premera increased copayments for existing tiers.