Value-based insurance design (VBID) bases cost sharing on a medication's clinical value, not its price. This study shows the effectiveness of VBID.

VBID allows policy-makers to remove barriers to medications by setting co-payments lower for more effective medications or more cost-effective medications within the same drug class.

This study was a pre, post quasi-experimental study with a retrospective cohort, specifically looking at whether a VBID program improved medication adherence in eight drug classes over two years of implementation.

Brand-name medication co-payments were lowered for all enrollees from tier 3 to tier 2. Generic co-payments were waived for employers who opted into the VBID program. Medication adherence of the VBID program participants and nonparticipants was measured 12 months before and 12 and 24 months after program participation, using estimations on eight propensity-matched cohorts.

Key Findings:

• Medication adherence improved from 1.4 percent to 3.2 percent during the first year.
• Two years after VBID implementation, medication adherence improved from 2.1 percent to 5.2 percent.
• The adherence changes were most notable among previously nonadherent patients.

More studies examining the economic impact of VBID are needed to ensure successful VBID design and implementation under the Patient Protection and Affordable Care Act (ACA).