It seems like drug savings and greater use of generic drugs that ACO (Accountable Care Organization) advocators hope for did not materialize.
ACO is an association of hospitals, healthcare providers, and insurers in which all parties voluntarily assume financial and medical responsibility for Medicare patients.
ACO advocators have held out hope that the organization would extend to pharmaceutical spending, leading to greater use of generic drugs instead of highly expensive brand-name drugs.
A study of a commercial ACO, reported in the August issue of Health Services Research, is not promising, as it shows that the ACO has a negligible effect on generic prescriptions and drug expenditures, according to Managed Healthcare Executive (MHE).
The study’s lead author Hui Zhang and colleagues said that ACOs have to go further with policies and programs to reduce drug expenditures.
Zhang, who is a researcher in the health policy research division of the California Public Employees’ Retirement System (CalPERS), and his team had data on a study population of about 40,000 CalPERS non-Medicare members.
Of those, 20,000 CalPERS members were “never” attributed to an ACO, around 12,000 were “always” attributed to an ACO, and another 8,000 were “mixed,” between 2010 and 2014.
The investigators compared the groups “never” and “always” to assess the effect of the ACO on various aspects of drug expenditures.
They found “no meaningful change” in per member, per year average total allowed payments for generic or brand-name drugs between the “never” and the “always” groups.
Also, utilization statistics showed no difference between “never” and “always” groups.
The use of generics substitutes was higher for the “always” group compared to the “never” group.
The authors said, “We did not find meaningful ACO improvement for selected medication-related quality measures, which is worrisome especially for the at-risk population since the ACO targeted chronic condition care management.”
They also noted that the PBM (Pharmacy Benefit Manager) benefit and design likely had an effect on the ACO’s impact on utilization and spending. The article originally appeared on MHE.
