Evaluating the Impact of a Value-based Prescription Drug Formulary

Study Overview
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Brief Summary
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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.

Official Title
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Value-based Formulary-Essentials: Testing and Expanding on Value in Prescription Drug Benefit Design

Conditions
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Value-Based Health Insurance

Intervention / Treatment
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* Other: Value-based Formulary


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 0 Years
Maximum Age: 64 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Value-based Formulary Beneficiaries<br>enrolled in the value-based formulary | Other: Value-based Formulary<br>* Prescription drug formulary tiers informed by estimated value<br>|
| Standard Formulary Beneficiaries<br>enrolled in a standard (i.e., non-value-based formulary) | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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 | From 24 months before insurance transition until up to 36 months after transition | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient out-of-pocket spending for prescription drugs | Impact of value-based formulary on patient out-of-pocket spending for prescription drugs per member per month | From 24 months before insurance transition until up to 36 months after transition | 
| Health plan spending for prescription drugs | Impact of value-based formulary on health plan spending for prescription drugs per member per month | From 24 months before insurance transition until up to 36 months after transition | 
| Total healthcare spending | Impact of value-based formulary on total healthcare spending per member per month | From 24 months before insurance transition until up to 36 months after transition | 
| Number of emergency department visits | Impact of value-based formulary on number of emergency department visits per member per month | From 24 months before insurance transition until up to 36 months after transition | 
| Number of days in hospital | Impact of value-based formulary on number of days in hospital per member per month | From 24 months before insurance transition until up to 36 months after transition | 
| Number of outpatient office visits | Impact of value-based formulary on number of outpatient office visits per member per month | From 24 months before insurance transition until up to 36 months after transition | 
| Days supply of medication | Impact of value-based formulary on days supply of medication per member per month | From 24 months before insurance transition until up to 36 months after transition | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Formularies as Topic, Cost Sharing / economics, Insurance, Health / economics, Value-Based Health Insurance / economics