Advanced Search

Impact of Three-Tier Pharmacy Benefit Structures on Consumer Attitudes, Pharmacy, Medical Utilization and Costs: A Critical Review

Contents:

Author Info

  • Kavita V. Nair

    (School of Pharmacy, University of Colorado Health Sciences Center, Denver, Colorado, USA)

  • Robert J. Valuck

    (School of Pharmacy, University of Colorado Health Sciences Center, Denver, Colorado, USA)

Registered author(s):

    Abstract

    Three-tier pharmacy benefit plans are the dominant structure in prescription drug coverage today. In these plans three copayments exist. The lowest copayment is for generics, the middle copayment is for preferred brands and the highest copayment is for non-preferred brands. The premise of these plans is that by shifting the burden of cost onto the consumer, consumers will be more judicious in their prescription purchasing behavior. This review article outlines the empirical evidence regarding the utility of three-tier plans in changing consumer The results from a few key studies appear to suggest that three-tier plans reduce prescription drug spending for health plans while significantly increasing the cost-sharing amount for consumers. While the increased cost sharing created higher levels of dissatisfaction among three-tier plan members, it appears that they modify their behavior in accordance with these plans by switching to lower cost formulary alternatives. The factors that appeared to affect these behaviors included provider opinion and the comparability of the formulary and non-formulary alternatives. However, there are a myriad of factors that could influence the decision to switch from one drug to another (one example is switching for purely clinical reasons), and thus a clear link between the implementation of three-tier plans and switching behavior is hard to establish. What still remains unanswered is the impact of three-tier plans on vulnerable populations such as the elderly, low-income individuals and individuals with chronic disease who may be most adversely affected by the implementation of such policies. These individuals may discontinue or reduce appropriate utilization of their medications that could lead to adverse outcomes. Adequate follow-up for these vulnerable populations who are enrolled in a three-tier plan needs to be conducted to ensure appropriate medication use.

    Download Info

    If you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.
    File URL: http://diseasemanagement.adisonline.com/pt/re/dmo/pdfhandler.00115677-200412020-00002.pdf
    Download Restriction: Pay per view
    File URL: http://diseasemanagement.adisonline.com/pt/re/dmo/fulltext.00115677-200412020-00002.htm
    Download Restriction: Pay per view

    As the access to this document is restricted, you may want to look for a different version under "Related research" (further below) or search for a different version of it.

    Bibliographic Info

    Article provided by Wolters Kluwer Health | Adis in its journal Disease Management & Health Outcomes.

    Volume (Year): 12 (2004)
    Issue (Month): 2 ()
    Pages: 81-92
    Download reference. The following formats are available: HTML (with abstract), plain text (with abstract), BibTeX, RIS (EndNote, RefMan, ProCite), ReDIF
    Handle: RePEc:wkh:dmhout:v:12:y:2004:i:2:p:81-92

    Contact details of provider:
    Web page: http://diseasemanagement.adisonline.com/

    For corrections or technical questions regarding this item, or to correct its listing, contact: (Dave Dustin).

    Related research

    Keywords: Cost-allocation; Drug-utilisation; Patient-preference;

    Find related papers by JEL classification:

    References

    No references listed on IDEAS
    You can help add them by filling out this form.

    Citations

    Lists

    This item is not listed on Wikipedia, on a reading list or among the top items on IDEAS.

    Statistics

    Access and download statistics

    Corrections

    When requesting a correction, please mention this item's handle: RePEc:wkh:dmhout:v:12:y:2004:i:2:p:81-92

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Dave Dustin).

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If references are entirely missing, you can add them using this form.

    If the full references list an item that is present in RePEc, but the system did not link to it, you can help with this form.

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.