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The types of industries represented by the underwritten and self-insured employers included in the study differed. The most common categories for the underwritten group were professional, scientific, and technical services; special trade contractors; ambulatory health care services; educational services; and executive, legislative, and public finance. The most common categories for the self-insured groups were utilities; credit intermediation and related activities; food and beverage stores; hospitals; and executive, legislative, and public finance
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The types of industries represented by the underwritten and self-insured employers included in the study differed. The most common categories for the underwritten group were professional, scientific, and technical services; special trade contractors; ambulatory health care services; educational services; and executive, legislative, and public finance. The most common categories for the self-insured groups were utilities; credit intermediation and related activities; food and beverage stores; hospitals; and executive, legislative, and public finance.
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We included drugs considered to be combination products in analyses of the categories for each of the therapeutic active ingredients. For example, an enrollee who switched from a statin and calcium-channel blocker to a combination therapy containing those active ingredients would have the days' supply for the combination therapy counted toward his or her medication possession ratios for both statins and calcium-channel blockers
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We included drugs considered to be combination products in analyses of the categories for each of the therapeutic active ingredients. For example, an enrollee who switched from a statin and calcium-channel blocker to a combination therapy containing those active ingredients would have the days' supply for the combination therapy counted toward his or her medication possession ratios for both statins and calcium-channel blockers.
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The inclusion of a nonequivalent dependent variable strengthened the internal validity of the adherence differences that we observed. We expected trends in angiotensinreceptor blocker adherence to be similar in the two groups because, as noted in the text, these drugs were available only as brand-name medications, and copays for such medications were reduced for both groups. Thus, we did not expect to see any impact of program implementation on adherence for these drugs. If there was a difference between the two groups, it would raise the question of whether the diverging trends that we saw in adherence with other medications were due to a factor like the one driving the difference with angiotensin-receptor blockers. As expected, we did not see any difference with these drugs; thus, we have greater confidence that the differences we saw with other drugs were due to the valuebased insurance design program, rather than to other factors.
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