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

> **NIH NIH R18** · KAISER FOUNDATION RESEARCH INSTITUTE · 2020 · $682,757

## Abstract

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.

## Key facts

- **NIH application ID:** 9935044
- **Project number:** 5R18DK110773-04
- **Recipient organization:** KAISER FOUNDATION RESEARCH INSTITUTE
- **Principal Investigator:** Alyce Sophia Adams
- **Activity code:** R18 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $682,757
- **Award type:** 5
- **Project period:** 2017-06-01 → 2022-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9935044

## Citation

> US National Institutes of Health, RePORTER application 9935044, Does Free Medicines Coverage Improve Diabetes Self-Care and Outcomes for Diverse Populations? (5R18DK110773-04). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9935044. Licensed CC0.

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