Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #111763

Dominic Hodgkin, PhD¹, Cindy Parks Thomas, PA, PhD², Linda Simoni-Wastila, PhD³, Grant A. Ritter, PhD⁴, Sue Lee⁴, and Van Doren Hsu, PharmD³. (1) Schneider Institute for Health Policy, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS 035, Waltham, MA 02454, 781-736-8551, hodgkin@brandeis.edu, (2) Schneider Institute for Health Policy, Brandeis University, Heller School for Social Policy and Management, P.O. Box 9110, 415 South Street, Waltham, MA 02454-9110, (3) Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 515 West Lombard Street, Room 162, Baltimore, MD 21201, (4) Schneider Institute for Health Policy, Heller Graduate School, Brandeis University, MS 035, 415 South Street, Waltham, MA 02454-9110

US insurers are increasingly adopting the tiered formulary, which uses differential copayments to steer patients toward generic drugs, or brand drugs for which the insurer has negotiated a discount (‘preferred brands'). These approaches may save insurers money by changing utilization, or by shifting the cost of a given utilization level onto enrollees. Utilization changes may affect medication adherence and health outcomes. These issues are important for depression, and antidepressant drugs account for a sizeable share of pharmacy costs at many health plans. Some analysts have speculated that utilization might be less price-responsive for antidepressants than for some other drug classes. In 2000, Tufts Health Plan (THP) began staggered implementation of a three-tier drug copayment program. The change moved several antidepressants (and other drugs) to a new third tier requiring copayment of $25 (instead of $10). Our sample comprises 212,000 THP members. Using insurance claims data, we examine the impact of the three-tier program on drug utilization patterns and expenditures, with a difference-in-difference design comparing affected and unaffected enrollee groups. Preliminary results indicate that utilization of the drugs that became ‘non-preferred' decreased in the affected enrollee group, with a 10% drop in the proportion of enrollees using them and an increase in use of other antidepressants. For the comparison group, a smaller decrease (5%) was observed. These results suggest that the tiered formulary did redirect some utilization away from non-preferred drugs. This study finds evidence that the choice among antidepressants does respond to out-of-pocket price, contrary to some expectations.

Learning Objectives: After attending this session, participants will be able to

• Identify the different cost-sharing tiers used in a 3-tier formulary.
• Discuss why a 3-tier formulary might affect use of antidepressant medications
• Explain how antidepressant use was affected by a 3-tier formulary in one particular health plan.

Keywords: Managed Care, Prescription Drug Use Patterns

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.