+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Value-Based Insurance Design Pharmacy Benefits for Children and Youth With Special Health Care Needs: Principles and Opportunities



Value-Based Insurance Design Pharmacy Benefits for Children and Youth With Special Health Care Needs: Principles and Opportunities



Pediatrics 139(Suppl 2): S117



Value-based insurance design (VBID) represents an innovative approach to health insurance coverage. In the context of pharmacy benefits, the goal of VBID is to minimize access barriers to the most effective and appropriate treatments for specific medical conditions. Both private and public insurance programs have explored VBID pharmacy projects primarily for medical conditions affecting adults. To date, evidence for VBID pharmacy programs for children and youth with special health care needs (CYSHCN) appears lacking. There appears to be potential for VBID concepts to be applied to pharmacy coverage benefiting CYSHCN. An overview of VBID pharmacy principles and guiding principles are presented. Opportunities for the creation of pharmacy programs with a value-based orientation and challenges to the redesign of pharmacy benefits are identified. VBID pharmacy coverage principles may be helpful to improve medication use and important clinical outcomes while lowering barriers to medication use for the population of CYSHCN. Pilot projects of VBID pharmacy benefits for children and youth should be explored. However, many questions remain.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 060457424

Download citation: RISBibTeXText

PMID: 28562309

DOI: 10.1542/peds.2016-2786f


Related references

Opportunities to create nurse-directed, evidence-based services and programs for children and youth with special health care needs and developmental disabilities. Journal of Pediatric Nursing 27(6): 605-606, 2012

Critical Health Issues for Children and Youth || Beyond Benefits: The Importance of a Pediatric Standard in Private Insurance Contracts to Ensuring Health Care Access for Children. The Future of Children 4(3): 115-133, 1994

A longitudinal study of a pediatric practice-based versus an agency-based model of care coordination for children and youth with special health care needs. Maternal and Child Health Journal 13(5): 667-676, 2009

Can broader diffusion of value-based insurance design increase benefits from US health care without increasing costs? Evidence from a computer simulation model. Plos Medicine 7(2): E1000234, 2010

Differences in Health Care Needs, Health Care Utilization, and Health Care Outcomes Among Children With Special Health Care Needs in Ohio: A Comparative Analysis Between Medicaid and Private Insurance. Journal of Public Health Management and Practice 23(1): E1, 2017

Statement of the Problem: Health Reform, Value-Based Purchasing, Alternative Payment Strategies, and Children and Youth With Special Health Care Needs. Pediatrics 139(Suppl 2): S89-S98, 2017

Transition planning for youth with special health care needs: results from the National Survey of Children with Special Health Care Needs. Pediatrics 115(6): 1562-1568, 2005

Children with special health care needs enrolled in the State Children's Health Insurance Program (SCHIP): patient characteristics and health care needs. Pediatrics 112(6 Pt 2): E508, 2003

A family-centered, community-based system of services for children and youth with special health care needs. Archives of Pediatrics and Adolescent Medicine 161(10): 933-936, 2007

Satisfaction with care and ease of using health care services among parents of children with special health care needs: the roles of race/ethnicity, insurance, language, and adequacy of family-centered care. Pediatrics 117(4): 1184-1196, 2006

Improved health care among children with special health care needs after enrollment into the State Children's Health Insurance Program. Ambulatory Pediatrics 7(1): 10-17, 2007

Insurance for children with special health care needs: patterns of coverage and burden on families to provide adequate insurance. Pediatrics 114(2): 394-403, 2004

Special Conference Issue: Strategies to Expand Health Insurance for Working Americans || Increasing Health Insurance Coverage through an Extended Federal Employees Health Benefits Program. Inquiry - Journal of Health Care Organization, Provision and Financing 38(2): 177-192, 2001

Does public insurance provide better financial protection against rising health care costs for families of children with special health care needs?. Medical Care 46(10): 1064-1070, 2008

Health Care Reform || Providing Primary Health Care to Children: Integrating Primary Care Services with Health Insurance Principles. Future of Children 3(2): 60-76, 1993