HealthLeaders-InterStudy, a leading provider of managed care market intelligence, reports that Illinois businesses and insurers are rethinking drug utilization as a component of healthcare costs by turning to value-based pharmacy design to lower costs. According to the latest Illinois Health Plan Analysis, this idea has moved into Illinois with the work of insurers like Health Alliance Medical Plans, which plans to expand its program to include new conditions.
Value-based pharmacy design (VBD) moves the costs of diagnosis and treatment for certain conditions, including drugs and supplies, down to the tier with the lowest copay or no copay at all if they are deemed to be essential to maintain health. The result is a formulary system that places some branded drugs to lower copay levels and generics to higher cost levels.
"In addition to Health Alliance, look for other insurers to apply value- based pharmacy design in the state, particularly with their diabetes and cardiovascular patients," states Roy Moore, market analyst for HealthLeaders- InterStudy and author of the report. "Results are defined as improvements in medication adherence, following the thought that by reducing a member's copay, they are more likely to be adherent, which will lead to better outcomes and lower medical costs."
Under several pilot programs, Health Alliance has offered employers VBD as part of a broader health and wellness program involving workplace wellness and preventive medicine measures. On July 1, 2008, Health Alliance is rolling out VBD to its fully insured risk group with a 10 percent coinsurance rate for diabetes drugs to its members, but no step therapy or prior authorization. The insurer is looking to expand the program to new conditions likes cardiovascular disease, osteoporosis and asthma.
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