This article is more than 5 years old. Information may no longer be current.

$0 copay within employee wellness program leads to cost savings

Eliminating drug copayments, within the context of a larger employee wellness program and targeting the appropriate population, can lead to cost savings, according to data published the American Journal of Managed Care.

“[Value-based insurance design (VBID)] is generally characterized by the reduction of financial barriers to the purchase of services that provide ‘high value,’ such as use of lower-cost medications and preventive screenings,” Daniel D. Maeng, PhD, of Geisinger Health System, in Danville, Pennsylvania, and colleagues wrote. “In theory, the investment of providing such high-value benefits would be more than offset by the avoidance of more expensive medical events. … To date, VBID — in the context of prescription drugs — has demonstrated improved medication adherence and certain health-related outcomes, but no obvious cost savings.”

To determine the financial impact of a $0 copay prescription drug program implemented as part of an employee wellness program, the researchers examined claims data for the approximately 200 antihypertensive, antidiabetic or antilipid medications covered by the program. The study included Geisinger Health System employees covered under the company’s 2007 health plan, with claims data from 2005 to 2011. The study was limited to continuously enrolled members with Geisinger primary care providers throughout the study period.

The intervention group included 2,251 employees who received drugs eligible for the $0 copay. They were propensity score matched to a control group based made up of 3,857 individuals not employed with Geisinger Health System who received the same eligible drugs at the same time.

According to the researchers, total health care spending, including medical and prescription drugs, was lower among Geisinger Health System employees by 13%, or $144 per-member-per-month (95% CI, 38-250) during the months when they were taking any of the eligible drugs.  They estimated the return on investment, after accounting for drug acquisition cost and the foregone copay, to be 1.8 over a 5-year period.

“This finding suggests that VBID implementation within the context of a wider employee wellness program targeting the appropriate population can potentially lead to net positive cost savings,” Maeng and colleagues wrote. “We note, however, this study does not examine the long-term impact of VBID. To do so, a different methodological approach is necessary to account for the employees’ choice to enroll and disenroll from the program, as well as its changing design (eg, changes in the number of $0 copay-eligible drugs) over time. This is an important area for future research, as the long-term success of VBID depends on its ability to induce permanent changes in patient behaviors.” – by Jason Laday

Disclosure: Maeng reports employment with Geisinger Health System. See the full published article for additional author disclosures.