VBID, the PPACA, and FREEE Medications: Did Politics Trump the Evidence About Cost Sharing?

The evidence available to date suggests that copayment reductions/waivers provided to commercially insured populations, especially when applied in primary prevention and/or to brand drugs in therapy classes with generic alternatives, are unlikely to yield meaningful health improvements and may direct scarce resources away from financing therapy areas in which patients have no generic alternatives, such as biopharmaceuticals. The slow uptake of copayment reduction/waiver strategies among private payers is appropriate. Although Post-MI FREEE certainly represented a major step forward in a research field littered with studies that are weakly designed and/or nontransparently reported, its results suggest the need for continued caution in VBID adoption. The Post-MI FREEE trial report differed in important ways from the a priori analysis plan, and observed effect sizes were small. Until utilization analyses are reported, the Post-MI FREEE results have limited applicability to MCO costs, and even when fully reported, the Post-MI FREEE results should not be applied to primary prevention.