Implementing a value-based drug formulary that uses cost-effectiveness analyses after safety and efficacy decreased pharmacy costs by 3% in the first year, according to a study published in the Journal of Managed Care & Specialty Pharmacy.
Implementing a value-based drug formulary (VBF) that uses cost-effectiveness analyses after safety and efficacy decreased pharmacy costs by 3% in the first year, according to a study published in the Journal of Managed Care & Specialty Pharmacy.
The researchers compared pharmacy cost per member per month during the first year of implementation of the Premera Blue Cross VBF with 2 groups: observed pharmacy costs in the year prior to implementation and expected costs if no changes had been made to the pharmacy benefits.
The VBF is a 4-tier formulary system with an additional preventive drug tier, which is not subject to member cost sharing. Higher value drugs were placed in lower tiers, and subject to lower copayments. The preventive tier comprised of 39.9% of drugs, and tiers 1, 2, 3, and 4 included 14%, 36%, 7.4%, and 2.7% of drugs after implementation of VBF.
“In traditional formularies, drugs with lower copayments tend to have low acquisition costs,” the authors wrote. “However, since value is defined based on a ratio of costs to benefits, it is possible for high-cost drugs to achieve a lower tier status if the benefits outweigh the costs.”
The researchers also estimated the impact of the VBF on member cost share within 3 chronic disease cohorts: diabetes, hypertension, and hyperlipidemia.
In the year after the VBF was put in place, pharmacy plan payments decreased $7.82 per member per month, or 11%, compared with the estimated payments if no changes had been made to drug benefits.
Without a benefit change, the overall average member cost share for the chronic disease cohorts were expected to increase 12%, but the observed increase was 5% for diabetes, 8% for hypertension, and 2% for hyperlipidemia.
“We believe that a VBF will be well received in settings where a trust relationship exists between employer and associates, such that most associates believe that the employer cares about their health and is acting in their best interest,” the authors wrote.
Standard Criteria for Loss of Ambulation Needed in DMD
April 19th 2024A recent study suggests the differences between ambulation definitions for patients with Duchenne muscular dystrophy (DMD) can impact the identification of ambulant vs nonambulant individuals, and standard criteria across settings are needed.
Read More
Overcoming Employment Barriers for Lasting Social Impact: Freedom House 2.0 and Pathways to Work
April 16th 2024To help celebrate and recognize National Minority Health Month, we are bringing you a special month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. Welcome to our second episode, in which we learn all about Freedom House 2.0 and the Pathways to Work program.
Listen
Early Involvement Critical in Treating Immunotherapy-Induced Overlap Syndrome
April 19th 2024A series of case studies reveals the importance of early diagnosis and involvement of special teams of clinicians when dealing with potential cases of overlap syndrome, which encompasses myocarditis, myasthenia gravis, and immune checkpoint inhibitor–related myositis.
Read More
Making Giant Strides in Maternity Health Through Baby Steps
April 9th 2024To help celebrate and recognize National Minority Health Month, we are kicking off a special month-long podcast series with our strategic alliance partner, UPMC Health Plan. Welcome to our first episode, which is all about the Baby Steps Maternity Program and its mission to support women throughout every step of their pregnancy journey.
Listen