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Does Free Medicines Coverage Improve Diabetes Self-Care and Outcomes for Diverse Populations?

Award Number: R18DK110773
ORGANIZATION: NATIONAL INSTITUTE OF DIABETES & DIGESTIVE & KIDNEY DISEASES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: KDA (KNOWLEDGE/DEVELOPMENT/APPLICATION)

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PROJECT SUMMARY/ABSTRACT The financial burden of medications is a significant barrier to medication adherence and subsequent diabetes control. Benefit designs that reduce copayments for services that are seen to be more cost-effective (known as “value-based insurance designs” or VBIDs) continue to capture the attention of public and private insurers, employers, and policy makers as a strategy to improve adherence and reduce long-term costs. While VBID programs that reduce copayments for chronic illness medications have been shown to have a positive short- term impact on medication adherence, we know less about long-term sustainability of clinical gains over time, particularly when incentives are eliminated. Also, little is known about which factors affect who participates and who benefits when VBID programs are introduced by a health plan in a real-world, multi-employer setting. This study will evaluate the provision and discontinuation of a real-world VBID program called the WellRx Drug Rider -- a zero copay drug benefit offered to engage patients more effectively in their self-care. To take advantage of this unique natural experiment, we will use a multi-method approach including patient- mailed surveys, semi-structured interviews of patients, providers, and employers, and a quasi-experimental longitudinal study using pre-post with comparison group and patient-level interrupted time series with comparison series to evaluate the impact of WellRx among patients with diabetes. This study is motivated by four specific aims: (1) to examine determinants of decisions about WellRx participation among employers and patients with diabetes and assess differences in at-risk patient subgroups (e.g., race and socioeconomic status); (2) to examine changes in self-management, utilization and costs, and clinical outcomes (HbA1c, lipid, blood pressure control) over a 1-year baseline and up to 4-year follow-up, comparing patients whose employers offered the free program compared to propensity-matched patients whose employers did not; (3) to assess sustainability of outcomes following program discontinuation, comparing patients whose employers continue or choose to discontinue WellRx coverage in later follow-up years; and (4) to determine whether the changes observed in Aims 2 and 3 differ by race/ethnicity, income, education attainment, or baseline nonadherence. The proposed study addresses pragmatic questions in a real-world health system that is highly motivated to improve access to care, self-efficacy, and outcomes for a diverse population of patients with diabetes. Our findings will inform future efforts to create benefit designs that are provider-endorsed, align with patient needs, address barriers to patient engagement, and improve patient capacity to maintain effective diabetes control.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2023 ( Subtotal = -$313,579 )
2023	2020	KAISER FOUNDATION HOSPITALS	1800 HARRISON ST FL 16	OAKLAND	CA	94612	ALAMEDA	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	4	11/10/2022	NON-COMPETING CONTINUATION	-$313,579
														Subtotal = -$313,579

Issue Date FY: 2021 ( Subtotal = $0 )
2021	2020	KAISER FOUNDATION HOSPITALS	1800 HARRISON ST FL 16	OAKLAND	CA	94612	ALAMEDA	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	4	3/18/2021	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2020 ( Subtotal = $682,757 )
2020	2020	KAISER FOUNDATION HOSPITALS	1800 HARRISON ST FL 16	OAKLAND	CA	94612	ALAMEDA	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	4	9/10/2020	NON-COMPETING CONTINUATION	$682,757
														Subtotal = $682,757

Issue Date FY: 2019 ( Subtotal = $689,481 )
2019	2019	KAISER FOUNDATION HOSPITALS	1800 HARRISON ST FL 16	OAKLAND	CA	94612	ALAMEDA	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	3	5/24/2019	NON-COMPETING CONTINUATION	$689,481
														Subtotal = $689,481

Issue Date FY: 2018 ( Subtotal = $710,942 )
2018	2018	KAISER FOUNDATION HOSPITALS	1800 HARRISON ST FL 16	OAKLAND	CA	94612	ALAMEDA	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	2	5/30/2018	NON-COMPETING CONTINUATION	$710,942
														Subtotal = $710,942

Issue Date FY: 2017 ( Subtotal = $771,010 )
2017	2017	KAISER FOUNDATION HOSPITALS	1800 HARRISON ST FL 16	OAKLAND	CA	94612	ALAMEDA	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	1	5/22/2017	NEW	$771,010
														Subtotal = $771,010

Grand Total All Awards = $2,540,611

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Does Free Medicines Coverage Improve Diabetes Self-Care and Outcomes for Diverse Populations?

Award Number: R18DK110773

ORGANIZATION: NATIONAL INSTITUTE OF DIABETES & DIGESTIVE & KIDNEY DISEASES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: KDA (KNOWLEDGE/DEVELOPMENT/APPLICATION)

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