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ment and prevention of disease, drug benefit design should be expected to transition from a cost-management approach to a value-based approach. Patients should be expected to pay more when preference drives their decision. However, when legitimate health concerns, such as lack of efficacy or adverse events, can be documented, that evidence should support access to alternative medication choice, without financial burden to the patient. If access to drugs is determined by the drugs’ value to defined populations, then valuebased drug benefit design should lead to overall costefficiencies, by defining patient-target populations for drug access and not by defining this access by cost. Disclosure Statement Dr Brixner received honoraria from Pfizer for the preparation of this article.
14. Huskamp HA, Deverka PA, Epstein AM, et al. The effect of incentive-based formularies on prescription-drug utilization and spending. N Engl J Med. 2003;349:2224-2232. 15. Joyce GF, Escarce JJ, Solomon MD, Goldman DP. Employer drug benefit plans and spending on prescription drugs. JAMA. 2002; 288:1733-1739. 16. Kamal-Bahl S, Briesacher B. How do incentive-based formularies influence drug selection and spending for hypertension? Health Aff (Millwood). 2004;23:227-236. 17. Motheral B, Fairman KA. Effect of a three-tier prescription copay on pharmaceutical and other medical utilization. Med Care. 2001;39:1293-1304. 18. Rector TS, Finch MD, Danzon PM, et al. Effect of tiered prescription copayments on the use of preferred brand medications. Med Care. 2003;41:398-406. 19. Keehan S, Sisko A, Truffer C, et al. Health spending projections through 2017: the baby boom generation is coming to Medicare. Health Aff. 2008;27:w145-w155. 20. Pear R. Future bleak for bill to keep health records confidential. New York Times; 1999:A12.
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References 1. Henry J. Kaiser Family Foundation. Prescription Drug Trends—A Chartbook Update. Kaiser Family Foundation. http://www.kff.org/ rxdrugs/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=137 96. November 2001. Accessed March 22, 2008. 2. Henry J. Kaiser Family Foundation. Prescription Drug Trends. Kaiser Family Foundation. http://www.kff.org/rxdrugs/upload/3057_06.pdf. Updated May 2007. Accessed March 22, 2008. 3. Hoffman JM, Shah ND, Vermeulen LC, et al. Projecting future drug expenditures—2008. Am J Health Syst Pharm. 2008;65:234-253. 4. Hoffman JM, Shah ND, Vermeulen LC, et al. Projecting future drug expenditures—2006. Am J Health-Syst Pharm. 2006;63:123-138. 5. US Food and Drug Administration. Center for Drug Evaluation and Research Report to the Nation: 2005. Improving Public Health Through Human Drugs. http://www.fda.gov/cder/reports/rtn/2005/rtn2005.PPT. Updated August 2006. Accessed March 22, 2008. 6. CNN.com. US population now 300 million and growing. CNN.com. http://www.cnn.com/2006/US/10/17/300.million.over/index.html. Updated October 17, 2006. Accessed March 22, 2008. 7. Families USA. No Bargain: Medicare Drug Plans Deliver High Prices. Families USA Publication No. 07-101. http://www.familiesusa.org/ assets/pdfs/no-bargain-medicare-drug.pdf. Accessed April 25, 2008. 8. Hoffman JM, Shah ND, Vermeaulen LC, et al. Projecting future drug expenditures—2007. Am J Health Syst Pharm. 2007;64:298-314. 9. Hauber A, Gale EA. The market in diabetes. Diabetologia. 2006;49:247-252. 10. Brixner DI, Ghate SR, McAdam-Marx C, Maio V. Analysis of primary care prescribing patterns of antihypertensive agents (AAs) before and after publication of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Poster presented at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 9th Annual European Congress, October 28-31, 2006, Copenhagen, Denmark. 11. Einhorn PT, Davis BR, Massie BM, et al, for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) heart failure validation study: diagnosis and prognosis. Am Heart J. 2007;153:42-53. 12. Henry J. Kaiser Family Foundation. Cost-containment strategies for prescription drugs: assessing the evidence in the literature. http://www.kff.org/rxdrugs/upload/Cost-Containment-Strategies-forPrescription-Drugs-Assessing-The-Evidence-in-the-Literature-Report.pdf. Updated March, 2005. Accessed March 22, 2008. 13. American Society of Health-System Pharmacists. ASHP guidelines on formulary system management. Am J Health Syst Pharm. 1992;49:648-652.
AHDB Stakeholder Perspective Drug Expenditures’ Impact on Benefit Design HEALTH PLANS: Commercially sponsored health plans remain focused on aggressive costmanagement strategies for healthcare services that make sense to all stakeholders. As a premise for facilitating change, the authors may be naïve about the window of opportunity to introduce new solutions for healthcare expenditures, including pharmaceuticals. Although there may some respite in cost escalation as a result of brand blockbusters going generic, overall costs have not truly flattened from a health plan sponsor’s perspective. Current drug trends remain a concern, and alternatives, such as value-based strategies, are increasing from an interest perspective but not from the perspective of adoption across the greater marketplace. Some of the many issues associated with the concept of value-based benefit design is a lack of consensus on what constitutes such value, as well as what works for both the employee and the employer; how to implement a value-based plan; and what program design is the best for optimal economic outcomes for any specific plan sponsor. Employers and other plan sponsors are facing a recessionlike economy in the United States, along Continued on page 34 www.AHDBonline.com
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