Impact of a pharmacy benefit change on new use of mail order pharmacy among diabetes patients: The Diabetes Study of Northern California (DISTANCE)

Details

• Alternative Title:
  Health Serv Res
• Personal Author:
  Karter, Andrew J. ; Parker, Melissa M. ; Duru, O. Kenrik ; Schillinger, Dean ; Adler, Nancy E. ; Moffet, Howard H. ; Adams, Alyce S. ; Chan, James ; Herman, Willam H. ; Schmittdiel, Julie A.
• Description:
  Objective
  
  To assess the impact of a pharmacy benefit change on mail order pharmacy (MOP) uptake.
  
  Data sources/study setting
  
  Race-stratified, random sample of diabetes patients in an integrated healthcare delivery system.
  
  Study Design
  
  In this natural experiment, we studied the impact of a pharmacy benefit change that conditionally discounted medications if patients used MOP and prepaid 2 copayments. We compared MOP uptake among those exposed to the benefit change (n=2,442) and the reference group with no benefit change (n=8,148), and estimated differential MOP uptake across social strata using a difference-in-differences framework.
  
  Data collection/extraction methods
  
  Ascertained MOP uptake (initiation among previous non-users).
  
  Principal findings
  
  Thirty percent of patients started using MOP after receiving the benefit change vs. 9% uptake among the reference group (p<0.0001). After adjustment, there was a 26 percentage point greater MOP uptake (benefit change effect). This benefit change effect was significantly smaller among patients with inadequate health literacy (15% less), limited English proficiency (14% less) and among Latinos and Asians (24% and 15% less compared to Caucasians).
  
  Conclusions
  
  Conditionally discounting medications delivered by MOP effectively stimulated MOP uptake overall while unintentionally widened previously existing social gaps in MOP use because it stimulated less MOP uptake in vulnerable populations.
  
  
• Subjects:
  Aged California Deductibles And Coinsurance Diabetes Mellitus Female Humans Hypoglycemic Agents Insurance, Pharmaceutical Services Male Middle Aged Pharmaceutical Services Postal Service Socioeconomic Factors

  More +
• Keywords:
  Comparative Effectiveness Difference-in-differences Health Disparities Inverse Probability Treatment Weighting Mail Order Pharmacy Marginal Structural Model Pharmacy Benefit Designs
• Source:
  Health Serv Res. 50(2):537-559
• Pubmed ID:
  25131156
• Pubmed Central ID:
  PMC4329275
• Document Type:
  Journal Article
• Funding:
  R01DK081796/DK/NIDDK NIH HHSUnited States/ ; R01DK080726/DK/NIDDK NIH HHSUnited States/ ; U58 DP002641/DP/NCCDPHP CDC HHSUnited States/ ; P30 DK092924/DK/NIDDK NIH HHSUnited States/ ; R01 DK081796/DK/NIDDK NIH HHSUnited States/ ; P30 DK063720/DK/NIDDK NIH HHSUnited States/ ; U58 DP002721/DP/NCCDPHP CDC HHSUnited States/ ; R01 HD046113/HD/NICHD NIH HHSUnited States/ ; R01 AG032249/AG/NIA NIH HHSUnited States/ ; R01 DK065664/DK/NIDDK NIH HHSUnited States/ ; RC1 DK086178/DK/NIDDK NIH HHSUnited States/ ; R01DK65664/DK/NIDDK NIH HHSUnited States/ ; R01 DK080726/DK/NIDDK NIH HHSUnited States/
• Volume:
  50
• Issue:
  2
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:64259e37f0b8c1edfdd8da5186e53832b2f29ec60847783044f05eaafd186b6f
• Download URL:
  https://stacks.cdc.gov/view/cdc/30645/cdc_30645_DS1.pdf
• File Type:
  [PDF - 412.58 KB ]