Value-Based Health Insurance
Conditions
Keywords
Cost Sharing / economics, Formularies as Topic, Insurance, Health / economics, Value-Based Health Insurance / economics
Brief summary
The objective of this study is to evaluate the impact of the value-based formulary on patient out-of-pocket spending and health plan spending as well as the impact of the value-based formulary on medication use, emergency department visits, hospitalizations, and outpatient office visits.
Interventions
OTHERValue-based Formulary
Prescription drug formulary tiers informed by estimated value
Sponsors
Donaghue Medical Research Foundation
Kaiser Permanente
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
0 Years to 64 Years
Healthy volunteers
No
Inclusion criteria
* Individuals: * aged 0-64 * Continuously enrolled in an employer-sponsored health plan for at least 12 months (with one-month allowable gap) prior to the index date * For individuals in the exposed group, the index date is defined as the start date of value-based formulary implementation at the employer group level * For individuals in the control group, the index date is defined as the index date of the matched exposed individual * Employer groups: * that transition to the value-based formulary if they transitioned all enrollees in that employer group (no individual selection)
Exclusion criteria
\- Individuals with: * missing gender information * missing zip code level demographics at all member months
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total spending for prescription drugs | From 24 months before insurance transition until up to 36 months after transition | Impact of value-based formulary on patient out-of-pocket plus health plan spending on prescription drugs per member per month |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Health plan spending for prescription drugs | From 24 months before insurance transition until up to 36 months after transition | Impact of value-based formulary on health plan spending for prescription drugs per member per month |
| Total healthcare spending | From 24 months before insurance transition until up to 36 months after transition | Impact of value-based formulary on total healthcare spending per member per month |
| Number of emergency department visits | From 24 months before insurance transition until up to 36 months after transition | Impact of value-based formulary on number of emergency department visits per member per month |
| Patient out-of-pocket spending for prescription drugs | From 24 months before insurance transition until up to 36 months after transition | Impact of value-based formulary on patient out-of-pocket spending for prescription drugs per member per month |
| Number of outpatient office visits | From 24 months before insurance transition until up to 36 months after transition | Impact of value-based formulary on number of outpatient office visits per member per month |
| Days supply of medication | From 24 months before insurance transition until up to 36 months after transition | Impact of value-based formulary on days supply of medication per member per month |
| Number of days in hospital | From 24 months before insurance transition until up to 36 months after transition | Impact of value-based formulary on number of days in hospital per member per month |
Countries
United States
Outcome results
None listed