MIAMI BEACH — A value-based insurance program with lower copayments significantly increased use of medications for secondary prevention among people with diabetes, compared with traditional insurance coverage, according to a prospective, controlled study.
There was a nearly 5% increase in metformin use, an almost 9% increase in utilization of ACE inhibitors or angiotensin II receptor blockers (ARBs), and a greater than 9% increase in statin use among 1,777 diabetics with value-based insurance, compared with a control group of 3,273 diabetics with conventional insurance.
With value-based insurance design (VBID), copayments are lowered for procedures or medications deemed beneficial according to the evidence-based literature. At the same time, copayments are increased for services or drugs that are not well demonstrated to improve outcomes, Dr. Allison B. Rosen said at the annual meeting of the Society of General Internal Medicine.
VBID also improved the other primary study outcome, medication adherence. For example, there was a significant 7% increase in ACE/ARB adherence and a nonsignificant 4% increase in statin adherence in the intervention group.
Although evidence-based medicine supports use of many secondary prevention agents for people with diabetes, underutilization remains a concern, Dr. Rosen said. High out-of-pocket costs are often cited as a culprit, and VBID might make a difference by linking patient copayments to value.
“There are few rigorous studies to support these positive claims,” said Dr. Rosen of the University of Michigan, Ann Arbor.
So she and her colleagues enrolled active University of Michigan employees and their dependents with diabetes into a VBID program that reduced their copays for antihypertensive, lipid-lowering, and glucose-lowering agents starting in July 2006. The control patients were employees of other institutions or companies and their dependents with diabetes enrolled in the same managed care plan.
All participants had at least one glycemic drug prescription filled in the year before implementation and at least one prescription filled for a secondary preventive medication in the 12 months thereafter.
Medication utilization at baseline ranged from 53% for statins to 65% for metformin. Following implementation of the VBID program, there was a significant increase in use of medications from all drug classes in the intervention group, compared with the control group: Metformin use increased by 4.8%, ACE/ARB use by 8.5%, and statin use by 9.3%.
The study was funded by the National Institutes of Health, the University of Michigan, and the John A. Hartford Foundation.