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Influence of three-tier cost sharing on patient compliance with and switching of cardiovascular medications

Dowell, Margaret Anne

Abstract Details

2002, Master of Science, Ohio State University, Pharmacy.
Compliance with prescribed drug regimens can reduce health care spending while improving patient outcomes. Managed care organizations have begun requiring members to pay a higher proportion of costs for non-preferred brand drugs, a plan known as an incented formulary or tiered cost sharing. This study has two goals, to evaluate whether an incented formulary is associated with a change in patient compliance, and to discover whether patients switch to lower-cost medications after a cost-share increase for non-preferred brands. A retrospective database analysis of the prescription drug claims for a health plan that implemented an incented formulary was performed. Four cardiovascular drug classes were analyzed, Angiotensin Converting Enzyme Inhibitors, Angiotensin Receptor Blockers, Calcium Channel Blockers, and HMG CoA Reductase Inhibitors. Multivariate linear regression was used to explain the relationship between implementation of the incented formulary and difference in compliance measured using the Medication Possession Ratio (MPR) while controlling for covariates. No difference was found in changes in medication compliance between users of non-preferred brand drugs and users of preferred brand or generic drugs. Users of mail order pharmacy were more compliant than users of retail pharmacy. Analysis of switching among drug products using the Mantel-Haenszel chi square test of association estimated the effectiveness of the incented formulary implementation. Almost half of all subjects taking a non-preferred brand drug switched to a generic or preferred brand drug. Furthermore, efforts by the health plan to inform members of the change were not as effective as the cost share increase in encouraging members to switch to a lower-cost medication. Subjects were most likely to switch immediately after the cost-share increase. Subjects who used mail order at least once were three times more likely to switch drugs as those who used retail pharmacy exclusively. This thesis describes changes in refill compliance and switching of drug products after the implementation of an incented formulary. Including an incented formulary in a pharmacy benefit plan can save money for the plan while not reducing patient compliance with prescription drugs.
Craig Pedersen (Advisor)
190 p.

Recommended Citations

Citations

  • Dowell, M. A. (2002). Influence of three-tier cost sharing on patient compliance with and switching of cardiovascular medications [Master's thesis, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1030118543

    APA Style (7th edition)

  • Dowell, Margaret. Influence of three-tier cost sharing on patient compliance with and switching of cardiovascular medications. 2002. Ohio State University, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1030118543.

    MLA Style (8th edition)

  • Dowell, Margaret. "Influence of three-tier cost sharing on patient compliance with and switching of cardiovascular medications." Master's thesis, Ohio State University, 2002. http://rave.ohiolink.edu/etdc/view?acc_num=osu1030118543

    Chicago Manual of Style (17th edition)