How do incentive-based formularies influence drug selection and spending for hypertension?

Health Affairs

Volumn 23, Issue 1, 2004, Pages 227-236

  Kamal Bahl, Sachin ^a   Briesacher, Becky ^b  

^a UNIVERSITY OF MARYLAND SCHOOL OF PHARMACY   (United States)

^b UMB's Peter Lamy Center   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ANGIOTENSIN RECEPTOR ANTAGONIST; ANTIHYPERTENSIVE AGENT; CAPTOPRIL; DIPEPTIDYL CARBOXYPEPTIDASE INHIBITOR;

ARTICLE; ASSOCIATION; DRUG FORMULARY; DRUG FORMULATION; DRUG SELECTIVITY; HEALTH INSURANCE; HUMAN; HYPERTENSION; MEDICAL EXAMINATION; MEDICAL RESEARCH; PROSPECTIVE PAYMENT; STATISTICAL ANALYSIS;

DEDUCTIBLES AND COINSURANCE; FORMULARIES; HEALTH MAINTENANCE ORGANIZATIONS; HUMANS; HYPERTENSION; MOTIVATION; UNITED STATES;

EID: 2942683182     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.23.1.227     Document Type: Article

References (22)

1. S. Findlay, "Prescription Drug Expenditures in 2001: Another Year of Escalating Costs" (Washington: National Institute of Health Care Management Research and Education Foundation, May 2002).
2. Scott-Levin, Spring 2001 Managed Care Formulary Drug Audit (Newtown, Penn.: Scott-Levin, June 2000).
3. P. Penna, "Three-Tier Co-Pay Systems and Consumer-Centric Care," Journal of Managed Care Pharmacy 6, no. 5 (2000): 351-353.
4. B. Motheral and K.A. Fairman, "Effect of a Three-Tier Prescription Copay on Pharmaceutical and Other Medical Utilization," Medical Care 39, no. 12 (2001): 1293-1304; and G. Joyce et al., "Employer Drug Benefit Plans and Spending on Prescription Drugs," Journal of the American Medical Association 288, no. 14 (2002): 1733-1739.
5. B. Motheral and K.A. Fairman, "Effect of a Three-Tier Prescription Copay on Pharmaceutical and Other Medical Utilization," Medical Care 39, no. 12 (2001): 1293-1304; and G. Joyce et al., "Employer Drug Benefit Plans and Spending on Prescription Drugs," Journal of the American Medical Association 288, no. 14 (2002): 1733-1739.
6. R.E. Johnson et al., "The Effect of Increased Prescription Cost-Sharing on Medical Care Utilization and Expenses of Elderly Health Maintenance Organization Members," Medical Care 35, no. 11 (1997): 1119-1131; B.E. Harris, A. Stergachis, and E.D. Reed, "The Effect of Drug Copayments on Utilization and Cost of Pharmaceuticals in a Health Maintenance Organization," Medical Care 28, no. 10 (1990): 907-917; and B.R. Motheral and R. Henderson, "The Effect of a Copay Increase on Pharmaceutical Utilization, Expenditures, and Treatment Continuation," American Journal of Managed Care 5, no. 11 (1999): 1383-1394.
7. R.E. Johnson et al., "The Effect of Increased Prescription Cost-Sharing on Medical Care Utilization and Expenses of Elderly Health Maintenance Organization Members," Medical Care 35, no. 11 (1997): 1119-1131; B.E. Harris, A. Stergachis, and E.D. Reed, "The Effect of Drug Copayments on Utilization and Cost of Pharmaceuticals in a Health Maintenance Organization," Medical Care 28, no. 10 (1990): 907-917; and B.R. Motheral and R. Henderson, "The Effect of a Copay Increase on Pharmaceutical Utilization, Expenditures, and Treatment Continuation," American Journal of Managed Care 5, no. 11 (1999): 1383-1394.
8. R.E. Johnson et al., "The Effect of Increased Prescription Cost-Sharing on Medical Care Utilization and Expenses of Elderly Health Maintenance Organization Members," Medical Care 35, no. 11 (1997): 1119-1131; B.E. Harris, A. Stergachis, and E.D. Reed, "The Effect of Drug Copayments on Utilization and Cost of Pharmaceuticals in a Health Maintenance Organization," Medical Care 28, no. 10 (1990): 907-917; and B.R. Motheral and R. Henderson, "The Effect of a Copay Increase on Pharmaceutical Utilization, Expenditures, and Treatment Continuation," American Journal of Managed Care 5, no. 11 (1999): 1383-1394.
9. Joyce et al., "Employer Drug Benefit Plans."
10. Ibid.; Motheral and Fairman, "Effect of a Three-Tier Prescription Copay"; and C.P. Thomas et al., "Impact of Health Plan Design and Management on Retirees' Prescription Drug Use and Spending, 2001," 4 December 2002, www.healthaffairs.org/WebExclusives/Thomas_Web_Excl_120402.htm (23 October 2003).
11. Ibid.; Motheral and Fairman, "Effect of a Three-Tier Prescription Copay"; and C.P. Thomas et al., "Impact of Health Plan Design and Management on Retirees' Prescription Drug Use and Spending, 2001," 4 December 2002, www.healthaffairs.org/WebExclusives/Thomas_Web_Excl_120402.htm (23 October 2003).
12. Ibid.; Motheral and Fairman, "Effect of a Three-Tier Prescription Copay"; and C.P. Thomas et al., "Impact of Health Plan Design and Management on Retirees' Prescription Drug Use and Spending, 2001," 4 December 2002, www.healthaffairs.org/WebExclusives/Thomas_Web_Excl_120402.htm (23 October 2003).
13. A 2000 Scott-Levin report indicated that antihypertensive drug classes including ARBs, calcium-channel blockers, and ACE inhibitors are among the most likely to be included in differential copay systems.
14. Our study was not designed to address the impact of tiered formularies on the likelihood of any anti-hypertensive use or spending among patients with hypertension. A patient's decision on whether to use any antihypertensive medication at all is expected to be driven by the lowest copay level - that is, the copay amount for generic antihypertensives. We did not have much variation in the generic copayment across our study health plans; more than 80 percent of all plans had a generic copay of less than $5. Thus, we did not expect to see major differential impacts on any use or spending for antihypertensive drugs. This remains a question to be addressed by future research. People who changed plans were excluded to reduce potential bias from selection into another drug plan based on anticipated use.
15. Because of space limitations, we have not presented characteristics of the study sample. Significant differences were observed across most characteristics when the study sample was stratified by copay tier status and copay levels. These tables can be obtained from Sachin Kamal-Bahl at skama001@umaryland.edu.
16. These results held even in the multivariate analyses.
17. A logistic regression was also estimated to examine the association of copayment tiers on use of any brand medication. Enrollees in two-tier plans with the highest brand/generic copay differentials and three-tier plans had lower odds of using any brand medication, compared with those in single-tier plans with the lowest copayments.
18. P. Kanavos and U. Reinhardt, "Reference Pricing for Drugs: Is It Compatible with U.S. Health Care?" Health Affairs (May/June 2003): 16-30.
19. S. Schneeweiss et al., "Impact of Reference-Based Pricing for Angiotensin-Converting Enzyme Inhibitors on Drug Utilization," Canadian Medical Association Journal 166, no. 6 (2002): 737-745; and S. Schneeweiss et al., "Outcomes of Reference Pricing for Angiotensin-Converting-Enzyme Inhibitors," New England Journal of Medicine 346, no. 11 (2002): 822-829.
20. S. Schneeweiss et al., "Impact of Reference-Based Pricing for Angiotensin-Converting Enzyme Inhibitors on Drug Utilization," Canadian Medical Association Journal 166, no. 6 (2002): 737-745; and S. Schneeweiss et al., "Outcomes of Reference Pricing for Angiotensin-Converting-Enzyme Inhibitors," New England Journal of Medicine 346, no. 11 (2002): 822-829.
21. Kanavos and Reinhardt, "Reference Pricing for Drugs"; and A. Towse, "The Efficient Use of Pharmaceuticals: Does Europe Have Any Lessons for a Medicare Drug Benefit?" Health Affairs (May/June 2003): 42-45.
22. Kanavos and Reinhardt, "Reference Pricing for Drugs"; and A. Towse, "The Efficient Use of Pharmaceuticals: Does Europe Have Any Lessons for a Medicare Drug Benefit?" Health Affairs (May/June 2003): 42-45.