25131156

PMC4329275

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.

CDC Public Access

P30 DK063720/DK/NIDDK NIH HHS/United States
P30 DK092924/DK/NIDDK NIH HHS/United States
P30 DK092924/DK/NIDDK NIH HHS/United States
R01 DK065664/DK/NIDDK NIH HHS/United States
R01 DK080726/DK/NIDDK NIH HHS/United States
R01 HD046113/HD/NICHD NIH HHS/United States
R01DK080726/DK/NIDDK NIH HHS/United States
R01DK081796/DK/NIDDK NIH HHS/United States
R01DK65664/DK/NIDDK NIH HHS/United States
RC1 DK086178/DK/NIDDK NIH HHS/United States
U58 DP002641/DP/NCCDPHP CDC HHS/United States
U58 DP002721/DP/NCCDPHP CDC HHS/United States