Value-based insurance designs (VBIDs) for diabetes patients can improve outcomes while decreasing costs by incentivizing health-promoting consumer choices and behaviors such as treatment adherence.
But expectations for quick cost savings are frequently overblown, according to the speakers at the Academy of Managed Care Pharmacy (AMCP) 2017 Nexus.
“Value-based design for diabetes is difficult. We need to approach this with eyes wide open," said Pat Gleason, PharmD, FCCP, FAMCP, BCPS, of Prime Therapeutics, during the October 17 session.
"Don’t be distracted by shiny objects or snake oil. We have to be careful,” said Kenneth C. Mishler, PharmD, MBA, Blue Cross and Blue Shield of Kansas.
Twenty-nine million Americans live with diabetes mellitus, the majority of them—about 95%—with type 2 diabetes mellitus. It is important to distinguish type 1 and type 2 diabetes when designing VBID for diabetes management, said Mishler.
“Type 1 responds differently” to therapy, Mishler said.
“With microvascular complications like retinopathy and lower limb amputation, we’re going to be looking at the two groups independently as we think about specific elements of a value-based benefit design,” he explained. “It’s easy for us to throw all of those risk factors in one pool and say, if we do a better job of controlling blood glucose levels, we’ll get expected outcomes. But I think it’s clear that these do respond quite differently.”
About 20% of healthcare spending—$1 in every five—is spent on care of patients with diabetes, Mishler noted. Diabetes drugs alone account for $1 in $8 of presciption drug spending, he added. Diabetes management costs doubled in the three years between 2014 and 2017, posing a challenge to insurers and self-insured employers, he added.
“Clearly, the year-after-year growth show that we can’t continue on this path sustainably,” Mishler said. In 2016, 47% of diabetes prescriptions were filled with a generic diabetes drug.
Encouraging patients to comply with prescribed management plans is intuitively appealing, Mishler and Gleason noted. Reducing patients’ out-of-pocket costs for generic diabetes medications should reduce complication rates while reducing costs, for example, the reasoning goes.
But research suggests it’s not so simple, the experts said.