Journal Article

Adherence to Metformin, Statins, and ACE/ARBs Within the Diabetes Health Plan (DHP)

Li, Jinnan, Ho, Sam, Neugebauer, Romain, Chan, Charles, Ettner, Susan L., Luchs, Robert H., Keckhafer, Abigail M., Turk, Norman, Kimbro, Lindsay, Kirvan, Anya, Mangione, Carol M., Duru, O. Kenrik, Moin, Tannaz

2015

Overview

ABSTRACT Background Reducing patient cost-sharing and engaging patients in disease management activities have been shown to increase uptake of evidence-based care. Objective To evaluate the effect of employer purchase of a disease-specific plan with reduced cost-sharing and disease management (the Diabetes Health Plan/DHP) on medication adherence among eligible employees and dependents. Design Employer-level “intent to treat” cohort study, including data from eligible employees and their dependents with diabetes, regardless of whether they were enrolled in the DHP. Setting Employers that contracted with a large national health plan administrator in 2009, 2010, and/or 2011. Participants Ten employers that purchased the DHP and 191 employers that did not (controls). Inverse probability weighting (IPW) estimation was used to adjust for inter-group differences. Intervention The DHP includes free or low-cost medications and physician visits. Enrollment strategies and specific benefit designs are determined by the employer and vary in practice. DHP participants are notified up front that they must engage in their own health care (e.g., receiving diabetes-related screening) in order to remain enrolled. Main Outcome Measure Mean employee adherence to metformin, statins, and ACE/ARBs at the employer level at one year post-DHP implementation, as measured by the proportion of days covered (PDC). Results Baseline adherence to the three medications was similar across DHP and control employers, ranging from 64 to 69 %. In the first year after DHP implementation, predicted employer-level adherence for metformin (+4.9 percentage points, p = 0.017), statins (+4.8, p = 0.019), and ACE/ARBs (+4.4, p = 0.02) was higher with DHP purchase. Limitations Non-randomized, observational study. Conclusions The Diabetes Health Plan, an innovative health plan that combines reduced cost-sharing and disease management with an up-front requirement of enrollee participation in his or her own health care, is associated with a modest improvement in medication adherence at 12 months.

• Publisher: Springer US,Springer Nature B.V
• Subject: Adhesion / Adult / Aged / Angiotensin Receptor Antagonists - economics / Angiotensin Receptor Antagonists - therapeutic use / Angiotensin-Converting Enzyme Inhibitors - economics / Angiotensin-Converting Enzyme Inhibitors - therapeutic use / Antidiabetics / Cost Sharing - economics / Diabetes / Diabetes mellitus / Diabetes Mellitus, Type 2 - drug therapy / Diabetes Mellitus, Type 2 - economics / Disease control / Disease Management / Drug Costs - statistics & numerical data / Drugs / Employees / Employers / Female / Health Benefit Plans, Employee - economics / Health Benefit Plans, Employee - organization & administration / Health care / Humans / Hydroxymethylglutaryl-CoA Reductase Inhibitors - economics / Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use / Hypoglycemic Agents - economics / Hypoglycemic Agents - therapeutic use / Imidazoles - economics / Imidazoles - therapeutic use / Internal Medicine / Male / Medication Adherence - statistics & numerical data / Medicine / Medicine & Public Health / Metformin / Metformin - economics / Metformin - therapeutic use / Middle Aged / Original Research / Patient compliance / Rosuvastatin Calcium - economics / Rosuvastatin Calcium - therapeutic use / Statins / Tetrazoles - economics / Tetrazoles - therapeutic use / United States