17 October 2017 - - US-based pharmacy benefit manager Prime Therapeutics LLC found that implementing value based insurance designs does not lead to lower total cost of care for members, the company said.

VBID are benefits designed to maximize quality and decrease costs of health care by using financial incentives to drive to cost efficient services and increased member choice.

In the first half of 2017, for Prime's commercial book of business, diabetes was the number one non-specialty drug category in terms of spend, accounting for more than 13 % of the pharmacy benefit expense.

This cost was driven by a more than 4 % trend increase in spend from 2016 to 2017.

As one approach to help mitigate the growing diabetes medical costs, one of Prime's large, fully-insured health plans initiated a VBID for diabetes drugs within their commercial book of business.

This VBID lowered the insulin individual copay amount from its preferred formulary cost of USD 30 per 30-day supply to USD 15 and allowed for 100-day supply.

Also, for all diabetes drugs on formulary, a 100-day supply could be obtained for a single USD 15 copay for generics or USD 30 for preferred formulary diabetes drugs.

When analyzing integrated pharmacy (Prime) and medical (health plan) data, researchers found no difference in total cost of care between members with a VBID and those in a matched population of other health plans with standard benefits, after adjusting for background cost differences.

Prime Therapeutics LLC (Prime) helps people get the medicine they need to feel better and live well. Prime manages pharmacy benefits for health plans, employers, and government programs including Medicare and Medicaid.

The company processes claims and offers clinical services for people with complex medical conditions. Prime serves more than 20m people. It is collectively owned by 18 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans.