CVS Caremark research identifies optimal elements of effective VBID plans

WOONSOCKET, R.I. — New research conducted by CVS Caremark and Brigham and Women's Hospital identifies five key features of Value-Based Insurance Design plans that are associated with the greatest impact on medication adherence.



The study, which is published online Thursday in Health Affairs and also will appear in the journal's March issue, was funded by a grant from the Robert Wood Johnson Foundation's Changes in Health Care Financing and Organization Initiative.



A variety of pharmacy benefit structures — including copayments, co-insurance and deductibles — help payers contain healthcare spending by encouraging patients to actively consider and bear the cost of prescription medications. VBID plans take a different approach by reducing the cost to the patient for medications that offer higher clinical benefit with the intent that increased medication use would improve health outcomes and reduce overall healthcare spending. For example, patients in a VBID plan who have a chronic disease, such as high blood pressure, may have their out-of-pocket costs (e.g., copay) significantly reduced or eliminated for essential medications to treat their condition.



"For the first time, this research offers high-quality, empirical data on the VBID plan features that appear most effective for stimulating greater medication adherence," said Niteesh Choudhry, associate physician in the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women's Hospital, associate professor at Harvard Medical School and the lead author of the study. "The results show that several specific features can improve adherence from between two to five percentage points, and this information can help influence how future co-payment reduction plans are structured for optimal benefit."



The researchers evaluated 76 VBID plans provided by CVS Caremark to 33 plan sponsors and involving more than 274,000 patients. Based on the analysis, five key features were found to have a greater impact on adherence. These included:

• More generous VBID plans (e.g., those plans that had no cost-sharing for generic drugs and low monthly copayments of < or = $10 or co-insurance rates of < or = $15 for brand-name medications);


• Plans that targeted high-risk patients;


• Plans that had concurrent wellness programs;


• Plans that did not have concurrent disease management programs; and


• Plans that made the benefit available only by mail order, offering 90-day prescriptions.

"VBID plans have been popular with employers and health plans as a way to use financial incentives and other methods to encourage medication adherence, improve health outcomes and reduce overall healthcare costs," said William H. Shrank, SVP and chief scientific officer of CVS Caremark and a study co-author. "In order to optimize the benefits of VBID plans, these findings encourage more generous coverage for generics, greater use of 90-day prescriptions, more careful intervention targeting and expansion of wellness programs, all of which are active initiatives at CVS Caremark."



CVS Caremark is focused on developing programs to help improve medication adherence. The study described here helps improve the industry's overall understanding of medication adherence and enables CVS Caremark to develop more targeted, measureable programs to address the underlying behaviors that contribute to nonadherence.



CVS Caremark plans to use these research results, along with other key information, to identify, develop and pilot interventions that will help improve medication adherence for patients. The company is currently evaluating and piloting a number of interventions ranging from model development and prediction of adherence behavior to the use of medication reminder devices to help combat forgetfulness and improved labeling to address health literacy difficulties to digital interventions that engage patients to encourage adherence.



CVS Caremark has been supporting a multi-year research collaboration with Brigham and Women's Hospital to better understand patient behavior, particularly around medication adherence. Annual excess healthcare costs due to medication nonadherence in the United States have been estimated to be as much as $290 billion.