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.
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• Subjects:
  • Aged
  • California
  • Deductibles and Coinsurance
  • Diabetes Mellitus
  • Female
  • Humans
  • Hypoglycemic Agents
  • Insurance, Pharmaceutical Services
  • Male
  • Middle Aged
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• Keywords:
  • mail order pharmacy
  • pharmacy benefit designs
  • comparative effectiveness
  • health disparities
  • difference-in-differences
  • marginal structural model
  • inverse probability treatment weighting
• 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/
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• Volume:
  50
• Issue:
  2
• Download URL:
  https://stacks.cdc.gov/view/cdc/30645/cdc_30645_DS1.pdf
• File Type:
  [PDF - 412.58 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:64259e37f0b8c1edfdd8da5186e53832b2f29ec60847783044f05eaafd186b6f