Taking a medicine every day in the hopes that it will prevent some long-range potential health catastrophe like a heart attack or kidney failure. Many people skip doses, or do not refill their prescriptions on time, or at all.

But new evidence shows the power of a method aimed at changing this behavior: insurance plans that charge patients less for the medicines that could help them most. Some plans even make some of the medicines free to the patients with certain conditions.

In an article published in the July issue of Health Affairs, a team of researchers reports that this "value-based insurance design" approach led patients to fill their prescriptions more often.

"Enhanced access to high-value drugs that did not lead to an increase in total spending is a win/win for both insurers and patients," said Mark Fendrick, M.D., senior author of the new review and one of the originators of the VBID concept in the early 2000s.

"If total costs are equal, using more medicines that prevent costly hospitalizations is preferable to having people being admitted to a hospital," said Mark Fendrick

Fendrick directs the U-M Center for Value-Based Insurance Design and is a professor of internal medicine and health management and policy at the U-M Medical School and School of Public Health.

He worked on the study with Rajender Agarwal, MBA, who conducted the review of evidence while earning a master's degree in the business of medicine at Indiana University. Agarwal is now director of the Center for Health Reform in Texas. The center's associate director, Ashutosh Gupta, is a co-author.

Review of evidence

For the new article, the authors looked in detail at 21 studies that measured the impact of VBID-style prescription drug plans compared with more traditional plans.

The studies, all done in the last ten years, were held to a strict standard for evidence review called the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system.

The studies looked at the impact of VBID-style copays and co-insurance in which patients pay less, or pay nothing, for certain drugs that are known to provide high value for people with certain chronic conditions. They focused on drugs usually used long-term to prevent health issues in people with diabetes, high blood pressure, high cholesterol and asthma.

The researchers looked at the impact of low out-of-pocket costs for patients on their medication adherence, measured by how much of the medication the patient had obtained, compared with the duration of the prescription.

They also looked at what the studies found about the health care spending, use of health care services, and clinical outcomes and quality for patients in VBID plans compared with non-VBID plans.