Effects of a 3-Tier Pharmacy Benefit Design on the Prescription Purchasing Behavior of Individuals With Chronic Disease.

OBJECTIVE: To evaluate the impact of 3-tier (copayment) pharmacy benefit structures on medication utilization behavior. METHODS: A pretest-posttest quasi-experimental design was employed. Chronic disease sufferers (N=8,132) from a health plan were classified into the following groups: (a) 2-tier copayment moving to a 3-tier structure, ("converting" group), (b) 2-tier staying in a 2-tier structure and, (c) 3-tier staying in a 3-tier structure. The latter 2 were "comparison" groups. Two 7-month time periods were determined: the "preperiod" (June through December 2000) and the "postperiod" (January through July 2001) for a change in pharmacy benefit structure. Pharmacy claims data were used for data collection. Statistical analyses included bivariate tests to evaluate predifferences and postdifferences across study groups. Maximum likelihood estimates from a repeated measures model were used to examine changes in formulary compliance and generic use rates. Discontinuation of nonformulary medications was evaluated using logistic regression. RESULTS: Controlling for demographics, number of comorbidities, disease state, and pharmacy benefit structure, the formulary compliance rate increased by 5.6% for the converting group. No significant increases were seen for the comparison groups. Generic use rates increased by 6 to 8 absolute percentage points for all groups (3.3% to 4.9 % adjusted rates). Converting group members were 1.76 times more likely to discontinue their nonformulary medication than those in the 2-tier comparison group and 1.49 times more likely than those in the 3-tier comparison group. CONCLUSIONS: These findings suggest that shifting individuals from a 2-tier to a 3-tier drug benefit copayment structure resulted in changes in medication utilization. Decision makers need to balance these changes with the potential dissatisfaction that members may express in paying higher copayments. DISCLOSURES: Funding for this research was provided by Merck and Company through the Academic Medicine and Managed Care Forum and was obtained by authors Kavita V. Nair, Robert J. Valuck, Pamela Wolfe, Julie M. Ganther, and Marianne M. McCollum. Nair served as principal author of the study. Study concept and design was contributed by Nair, Valuck, Wolfe, Ganther, McCollum, and author Sonya J. Lewis. Analysis and interpretation of data and drafting of the manuscript were primarily the work of Nair and Wolfe, and all authors contributed to the critical revision of the manuscript. Statistical expertise was contributed by Wolfe. Administrative, technical, and/or material support was provided by Mark Enders.

Effects of a 3-tier pharmacy benefit design on the prescription purchasing behavior of individuals with chronic disease.

OBJECTIVE: To evaluate the impact of 3-tier (copayment) pharmacy benefit structures on medication utilization behavior. METHODS: A pretest-posttest quasi-experimental design was employed. Chronic disease sufferers (N=8,132) from a health plan were classified into the following groups: (a) 2-tier copayment moving to a 3-tier structure, (.converting. group), (b) 2-tier staying in a 2-tier structure and, (c) 3-tier staying in a 3-tier structure. The latter 2 were.comparison. groups. Two 7-month time periods were determined: the.preperiod. (June through December 2000) and the.postperiod. (January through July 2001) for a change in pharmacy benefit structure. Pharmacy claims data were used for data collection. Statistical analyses included bivariate tests to evaluate predifferences and postdifferences across study groups. Maximum likelihood estimates from a repeated measures model were used to examine changes in formulary compliance and generic use rates. Discontinuation of nonformulary medications was evaluated using logistic regression. RESULTS: Controlling for demographics, number of comorbidities, disease state, and pharmacy benefit structure, the formulary compliance rate increased by 5.6% for the converting group. No significant increases were seen for the comparison groups. Generic use rates increased by 6 to 8 absolute percentage points for all groups (3.3% to 4.9 % adjusted rates). Converting group members were 1.76 times more likely to discontinue their nonformulary medication than those in the 2-tier comparison group and 1.49 times more likely than those in the 3-tier comparison group. CONCLUSIONS: These findings suggest that shifting individuals from a 2-tier to a 3-tier drug benefit copayment structure resulted in changes in medication utilization. Decision makers need to balance these changes with the potential dissatisfaction that members may express in paying higher copayments.

Impact of multi-tiered pharmacy benefits on attitudes of plan members with chronic disease states.

OBJECTIVE: To evaluate the effects of 2- and 3-tiered pharmacy benefit plans on member attitudes regarding their pharmacy benefits. METHODS: We performed a mail survey and cross-sectional comparison of the outcome variables in a large managed care population in the western United States. Participants were persons with chronic disease states who were in 2- or 3-tier copay drug plans. A random sample of 10,662 was selected from a total of 25,008 members who had received 2 or more prescriptions for a drug commonly used to treat one of 5 conditions: hypertension, diabetes, dyslipidemia, gastroesophageal reflux disease (GERD), or arthritis. Statistical analysis included bivariate comparisons and regression analysis of the factors affecting member attitudes, including satisfaction, loyalty, health plan choices, and willingness to pay a higher out-of-pocket cost for medications. RESULTS: A response rate of 35.8% was obtained from continuously enrolled plan members. Respondents were older, sicker, and consumed more prescriptions than nonrespondents. There were significant differences in age and health plan characteristics between 2- and 3-tier plan members: respondents aged 65 or older represented 11.7% of 2-tier plan members and 54.7% of 3-tier plan members, and 10.0% of 2-tier plan members were in Medicare+Choice plans versus 61.4% in Medicare+Choice plans for 3-tier plan members (P<0.05). Controlling for demographic characteristics, number of comorbidities, and the cost of health care, 2-tier plan members were more satisfied with their plan, more likely to recommend their plan to others, and less likely to switch their current plans to obtain better prescription drug coverage than 3-tier plan members. While members were willing to purchase higher cost nonformulary and brand-name medications, in general, they were not willing to pay more than 10 dollars (in addition to their copayment amount) for these medications. Older respondents and sicker individuals (those with higher scores on the Chronic Disease Indicator) appeared to have more positive attitudes toward their pharmacy benefit plans in general. Higher reported incomes by respondents were also associated with greater satisfaction with prescription drug coverage and increased loyalty toward the pharmacy benefit plan. Conversely, the more individuals spent for either their health care or prescription medications, the less satisfied they were with their prescription drug coverage and less loyalty they appeared to have for their health plans. An inverse relationship also appeared to exist between the out-of-pocket costs for prescription medications and members' willingness to pay for nonformulary medications. CONCLUSIONS: Three-tier members had lower reported satisfaction with their plans compared to members in 2-tier plans. The financial resources available to members (which may be a function of being older and having more education and higher incomes), the number of chronic disease states that members have, and other factors may influence their attitudes toward their prescription drug coverage.