Key result
Incentive-based formularies linked to higher out-of-pocket costs and lower ACE inhibitor or ARB use.
Why the study?
The association between incentive-based formularies and antihypertensive drug selection and spending was not well characterized.
Observational
May discourage ACE inhibitor and ARB use via higher patient costs; leaves open effects on adherence, outcomes, and equity.
This study examined the association between incentive-based formularies and antihypertensive drug selection and spending. We compared the use of drugs from five drug classes by the number of tiers and copayment differentials. We found that raising copayments within a single-tier formulary system had a relatively modest impact on use of antihypertensives, compared with raising them in multi-tier systems. Likelihood of using ACE inhibitors and angiotensin II receptor blockers was lower among two-tier plans with generic/brand differentials of dollars 10 relative to flat-copayment plans. Incentive formularies were associated with lower total antihypertensive spending by plans, but enrollees paid more out of pocket.
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Kamal‐Bahl et al. (2004) conducted an observational in Hypertension. Incentive-based formularies (multi-tier systems) vs. Single-tier or flat-copayment plans was evaluated on Antihypertensive drug selection and spending. Incentive-based formularies were associated with lower plan spending but higher out-of-pocket costs, and a lower likelihood of using ACE inhibitors and ARBs in two-tier plans compared to flat-copay plans.
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