Evaluating the Impact of a Value-based Prescription Drug Formulary

Kaiser Permanente36,333 enrolled

Overview

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.

Study Type

OBSERVATIONAL

Enrollment

36,333

Conditions

Value-Based Health Insurance

Interventions

Value-based FormularyOTHER

Prescription drug formulary tiers informed by estimated value

Eligibility

Sex: ALLMin age: 0 YearsMax age: 64 Years

Medical Language ↔ Plain English

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

Locations (1)

Kaiser Permanente

Seattle, Washington, United States

Outcomes

Primary Outcomes

Total spending for prescription drugs

Impact of value-based formulary on patient out-of-pocket plus health plan spending on prescription drugs per member per month