Value based design in the news

Finding value in value based design? Yes we have.

October 9, 2019
Blue Cross and Blue Shield of Minnesota recently announced it will provide insulin to some members with zero-member costs at the point of sale in 2020.

That announcement made recent headlines. It came about through a Prime Therapeutics program that’s been around for 10 years: value based design (VBD) in plan benefit structures.

VBD lowers or eliminates out-of-pocket costs for drugs known to improve medical outcomes. For those conditions, adherence to available drugs is proven to improve member health. Prime’s VBD program is available for:

  • Diabetes
  • High blood pressure
  • Respiratory conditions

In addition, VBD can be structured for depression, tobacco cessation and weight loss.

“The goal of value based benefit design is clear,” said David Lassen, Prime’s chief clinical officer. “It’s intended to help keep members adherent to these important medicines to help improve member health and, ultimately, to lower total health care costs over the long term.”

Prime’s total drug management research into members with diabetes

Prime has conducted several studies on members with diabetes. Adherence is critical, but adherence alone has not been associated with short-term impact on medical event reduction. Several of Prime’s Blue Plan clients use a VBD strategy for members with diabetes.¹ They continue to do so, despite not yet seeing a medical event reduction to date. They understand the clinical studies and the importance of the long-term commitment. Over time, the total cost of care savings will become evident.

In the meantime, what we know about integrated medical and pharmacy management – or total drug management – has helped contain the growth of our clients’ diabetes drug trend.²

In Minnesota

The new Blue Cross and Blue Shield of Minnesota no-cost insulin program applies to members with fully insured commercial coverage. It also applies to Blue Cross and Blue Shield of Minnesota members covered by MinnesotaCare, a state-based health insurance program for people with low incomes.

In announcing the plan, Dr. Craig Samitt, president and CEO of Blue Cross and Blue Shield of Minnesota said: “Our first responsibility is to do what we can to improve the health and financial stability of our members. We felt a responsibility to address the skyrocketing cost of insulin with the options we have available. Hopefully our action will provide some measure of financial relief to many of our members who live with diabetes.”

  1. Bowen K, Vaughn M, Gleason PP. Zero Dollar Diabetes Drug Coverage: Impact on Utilization, Costs and Adherence. JMCP 2107:23(3-a):S44 Accessed August 1, 2017.
  2. Comparing 2017 mid-year trend to mid-year trend for 2016. Prime Therapeutics. Fall 2017 Mid-Year Update.

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