Evaluating the Impact of a Value-based Prescription Drug Formulary

Completed

• Conditions: Value-Based Health Insurance
• Interventions: Other: Value-based Formulary

• Registration Number: NCT04904055
• Lead Sponsor: Kaiser Permanente

Brief Summary

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.

Detailed Description

Not available

Study Timeline

• Study Start: 2015-01-01
• Primary Completion: 2019-12-31
• Study Completion: 2019-12-31
• Status Verified: 2021-05
• Study First Submitted: 2021-05-17
• Study First Submitted QC: 2021-05-21
• Last Update Submitted: 2021-05-21
• Study First Posted: 2021-05-27
• Last Update Posted: 2021-05-27

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 36333

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

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
Value-based Formulary Beneficiaries	Value-based Formulary	enrolled in the value-based formulary

Primary Outcome Measures

Name	Time	Method
Total spending for prescription drugs	From 24 months before insurance transition until up to 36 months after transition	Impact of value-based formulary on patient out-of-pocket plus health plan spending on prescription drugs per member per month

Secondary Outcome Measures

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

Trial Locations

Locations (1)

Kaiser Permanente; 🇺🇸 Seattle, Washington, United States