The new study in Health Affairs suggests that consumers do respond when health plans drop or reduce the cost of care. Blue Cross and Blue Shield of North Carolina paid an additional $6.4 million during a two-year period to cover the cost of higher drug use for patients with hypertension, diabetes, hyperlipidemia and congestive heart failure after the insurer lowered drug co-pays. That amounts to $139 to $173 annually for each member.
But the $5.7 million drop in the cost of all other care did not offset the expense.
“This study and prior ones suggest an increase in quality of care through greater adherence to medications, particularly for previously under-adherent patients,” wrote authors Matthew Maciejewski and Jennifer Lindquist of the Veterans Affairs Department, Daryl Wansink and John Parker of Blue Cross and Blue Shield of North Carolina, and Joel Farley of the University of North Carolina Chapel Hill.
“Although the quality of care improved, this study did not find that the associated expenditures were fully recovered within the time frame of our observation,” they said.
Health plans increasingly separate prescription coverage into tiers, with generic drugs and lower co-payments in one tier and another tier for more costly, brand-name drugs with higher co-payments.
In 2008, the North Carolina Blues reduced the cost of brand-name drugs by one tier for the conditions the researchers studied and offered generic medication for no cost to consumers.
Drug adherence increased by 2.7%-3.4% in 2008 and 2009 compared with 2007.
Hospital visits fell slightly, but researchers found no change in emergency room visits.
It was those with hypertension and coronary artery diseases—1 out of 3 also had diabetes—that saw the biggest drop in hospital visits and costs, the study said.
Benefits from better management of chronic diseases such as hypertension though consistent use of prescriptions likely won't be apparent in one or two years, Maciejewski said. “It's not entirely surprising that we don't see an immediate significant reduction” in expenses, he said. Over many years, however, patients that closely follow doctors' orders may avoid acute, costly illness. “It is in the realm of possibility.” But the evidence is not yet there. “It's an open question really.”
Also lacking are studies that analyze the relationship between value-based insurance design and clinical outcomes such as blood pressure and blood sugar, he said. “Improving medication adherence should be moving those in some degree and it's through those changes that we would expect to see lower healthcare expenditures.” More widespread use of electronic health records should make such research possible.