ArticleMedical care2017
Impact of a Value-based Formulary on Medication Utilization, Health Services Utilization, and Expenditures.
Article in Medical care, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
22 citing papers in PubMed, 1 synthesis or guideline pooled it.
- How to make value-based health insurance designs more effective? A systematic review and meta-analysis.The European journal of health economics : HEPAC : health economics in prevention and care · 2019Pooled it
- Zero Dollar Drug Copay program improves antidiabetic medication adherence and medication use patterns among Blue Cross and Blue Shield of Louisiana members with diabetes in Louisiana.BMJ open diabetes research & care · 2026Article
- How to Fix a Broken Health Care System: Pathways to Maximize Health and Well-being for All.Diabetes care · 2026Review
- The impact of a statewide insulin copay cap policy for insured patients with diabetes in Utah.Journal of managed care & specialty pharmacy · 2024Article
- Drug use and spending under a formulary informed by cost-effectiveness.Journal of managed care & specialty pharmacy · 2023Article
- Cost-Effectiveness of Systemic Treatments for Metastatic Castration-Sensitive Prostate Cancer: An Economic Evaluation Based on Network Meta-Analysis.Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research · 2022Article
- Strategies to Reduce Low-Value Cardiovascular Care: A Scientific Statement From the American Heart Association.Circulation. Cardiovascular quality and outcomes · 2022Review
- Availability of Cost-effectiveness Studies for Drugs With High Medicare Part D Expenditures.JAMA network open · 2021Article
- The effects of oral anticancer parity laws on out-of-pocket spending and adherence among commercially insured patients with chronic myeloid leukemia.Journal of managed care & specialty pharmacy · 2021Article
- Opportunities and Challenges of Value-Based Health Care: How Brazil Can Learn from U.S. Experience.Journal of managed care & specialty pharmacy · 2020Article
- Evolution of the AMCP Format for Formulary Submissions.Journal of managed care & specialty pharmacy · 2020Article
- Ensuring trustworthy use of artificial intelligence and big data analytics in health insurance.Bulletin of the World Health Organization · 2020Article
- A social prescriptions formulary: bringing social prescribing on par with pharmaceutical prescribing.Journal of the Royal Society of Medicine · 2019Review
- Adoption of Cost Effectiveness-Driven Value-Based Formularies in Private Health Insurance from 2010 to 2013.PharmacoEconomics · 2019Article
- Should national pharmacare apply a value-based insurance design?CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2019Article
- Are the Benefits of Value-Based Insurance Design Conclusive?Journal of managed care & specialty pharmacy · 2019Article
- Value-Based Insurance Design: Current Evidence and Future Directions.Journal of managed care & specialty pharmacy · 2019Article
- The potential price and access implications of the cost-utility and budget impact methodologies applied by NICE in England and ICER in the US for a novel gene therapy in Parkinson's disease.Journal of market access & health policy · 2018Article
- Using Performance-Based Risk-Sharing Arrangements to Address Uncertainty in Indication-Based Pricing.Journal of managed care & specialty pharmacy · 2017Article
- The Importance of Economic Perspective and Quantitative Approaches in Oncology Value Frameworks of Drug Selection and Shared Decision Making.Journal of managed care & specialty pharmacy · 2017Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
Abstract
backgroundValue-based benefit design has been suggested as an effective approach to managing the high cost of pharmaceuticals in health insurance markets. Premera Blue Cross, a large regional health plan, implemented a value-based formulary (VBF) for pharmaceuticals in 2010 that explicitly used cost-effectiveness analysis (CEA) to inform medication copayments. OBJECTIVE OF THE STUDY: The objective of the study was to determine the impact of the VBF.
designInterrupted time series of employer-sponsored plans from 2006 to 2013. SUBJECTS: Intervention group: 5235 beneficiaries exposed to the VBF. CONTROL GROUP: 11,171 beneficiaries in plans without any changes in pharmacy benefits.
interventionThe VBF-assigned medications with lower value (estimated by CEA) to higher copayment tiers and assigned medications with higher value to lower copayment tiers. MEASURES: Primary outcome was medication expenditures from member, health plan, and member plus health plan perspectives. Secondary outcomes were medication utilization, emergency department visits, hospitalizations, office visits, and nonmedication expenditures.
resultsIn the intervention group after VBF implementation, member medication expenditures increased by $2 per member per month (PMPM) [95% confidence interval (CI), $1-$3] or 9%, whereas health plan medication expenditures decreased by $10 PMPM (CI, $18-$2) or 16%, resulting in a net decrease of $8 PMPM (CI, $15-$2) or 10%, which translates to a net savings of $1.1 million. Utilization of medications moved into lower copayment tiers increased by 1.95 days' supply (CI, 1.29-2.62) or 17%. Total medication utilization, health services utilization, and nonmedication expenditures did not change.
conclusionsCost-sharing informed by CEA reduced overall medication expenditures without negatively impacting medication utilization, health services utilization, or nonmedication expenditures.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.