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Health Aff (Millwood). 2018 Jul;37(7):1057-1064. doi: 10.1377/hlthaff.2017.1633.

Value-Based Insurance Design Improves Medication Adherence Without An Increase In Total Health Care Spending.

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Rajender Agarwal ( ) is director of the Center for Health Reform, in Southlake, Texas. At the time this work was completed, he was a Business of Medicine MBA candidate at Indiana University's Kelley School of Business, in Indianapolis.
Ashutosh Gupta is associate director of the Center for Health Reform and a gastroenterologist at ProCare Gastroenterology, in Odessa, Texas.
A. Mark Fendrick is a professor in the Department of Internal Medicine, University of Michigan, in Ann Arbor.


Value-based insurance design (VBID) is a strategy that reduces cost sharing for high-value services and increases consumers' out-of-pocket spending for low-value care. VBID has increasingly been implemented by private and public payers and has inspired demonstration programs in Medicare Advantage and TRICARE. Given the recent publication of several studies, we performed an updated systematic review that evaluated the effects of reducing consumer cost sharing on medication adherence and other relevant outcomes. Searches were conducted in key online databases, and the screening of citations yielded twenty-one unique studies, of which eight had not been included in previous reviews. Using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system, we found moderate-quality evidence showing improvement (range: 0.1-14.3 percent) in medication adherence with VBID. This increase in adherence was associated with no effect on total health care spending, which suggests that the incremental drug spending was offset by decreases in spending for other health care services.


Healthcarereform; Medication Adherence; Systematic Review; VBID; Value-based Insurance Design


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