 |
|
Impact of 3-Tier Formularies on Drug Treatment of Attention-Deficit/Hyperactivity Disorder in Children
Haiden A. Huskamp, PhD;
Patricia A. Deverka, MD, MS;
Arnold M. Epstein, MD, MA;
Robert S. Epstein, MD, MS;
Kimberly A. McGuigan, PhD;
Anna C. Muriel, MD;
Richard G. Frank, PhD
Arch Gen Psychiatry. 2005;62:435-441.
Background Expenditures for medications used to treat attention-deficit/hyperactivity disorder (ADHD) in children have increased rapidly. Many employers and health plans have adopted 3-tier formularies in an attempt to control costs for these and other drugs.
Objective To assess the effect of copayment increases associated with 3-tier formulary adoption on use and spending patterns for ADHD medications for children.
Design and Setting Observational study using quasi-experimental design to compare effects on ADHD medication use and spending for children enrolled as dependents in an employer-sponsored plan that made major changes to its pharmacy benefit design and a comparison group of children covered by the same insurer. The plan simultaneously moved from a 1-tier (same copayment required for all drugs) to a 3-tier formulary and implemented an across-the-board copayment increase. The plan later moved 3 drugs from tier 3 to tier 2.
Participants An intervention group of 20 326 and a comparison group of 15 776 children aged 18 years and younger.
Main Outcome Measures Monthly probability of using an ADHD medication; plan, enrollee, and total ADHD medication spending; and medication continuation.
Results A 3-tier formulary implementation resulted in a 17% decrease in the monthly probability of using medication (P<.001), a 20% decrease in expected total medication expenditures, and a substantial shifting of costs from the plan to families (P<.001). Intervention group children using medications in the pre-period were more likely to change to a medication in a different tier after 3-tier adoption, relative to the comparison group (P = .08). The subsequent tier changes resulted in increased plan spending (P<.001) and decreased patient spending (P = .003) for users but no differences in continuation.
Conclusions The copayment increases associated with 3-tier formulary implementation by 1 employer resulted in lower total ADHD medication spending, sizeable increases in out-of-pocket expenditures for families of children with ADHD, and a significant decrease in the probability of using these medications.
Author Affiliations: Departments of Health Care Policy (Drs Huskamp and Frank) and Psychiatry (Dr Muriel), Harvard Medical School, Boston, Mass; Medco Health Solutions Inc (Drs Deverka, Epstein, and McGuigan), Franklin Lakes, NJ; Department of Health Policy and Management, Harvard School of Public Health (Dr Epstein), Boston; Section on Health Services and Policy Research, Department of Medicine, Brigham and Women’s Hospital (Dr Epstein), Boston; Department of Psychiatry, Massachusetts General Hospital (Dr Muriel), Boston. Dr Deverka is currently a Fellow at Duke University, Institute for Genome Sciences and Policy, Durham, NC, and Dr McGuigan is now an employee of Pfizer, New York, NY.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Effect of Cost-Sharing on Use of Asthma Medication in Children
Ungar et al.
Arch Pediatr Adolesc Med 2008;162:104-110.
ABSTRACT
| FULL TEXT
Prescription Drug Cost Sharing: Associations With Medication and Medical Utilization and Spending and Health
Goldman et al.
JAMA 2007;298:61-69.
ABSTRACT
| FULL TEXT
The Global Market For ADHD Medications
Scheffler et al.
Health Aff (Millwood) 2007;26:450-457.
ABSTRACT
| FULL TEXT
Insurers Turn to Escalating Copays As Cost-Containment Strategy
Moran
Psychiatr. News 2005;40:29-29.
FULL TEXT
|
