Prescription Claims According to Wellness Program Participation for an Insurance Company in the United States

Objective: To identify the number and total cost of prescription claims for a US insurance company by wellness program participation, baseline health, age, and sex. Methods: This is a retrospective analysis of 2250 individuals continuously employed from 2014 through 2016. Results: In 2014, ages ranged from 22 to 85 (M = 48.7, SD = 11.2), with 71.5% women. Program participation was 20.8% in 2014, 12% in 2015, and 27.5% in 2016, 37.2% overall. Participation was inversely related to age and greater in women (41.4% vs. 25.7%). Employees in the best and worst health at baseline went on to earn the fewest number of wellness participation points. The percent of employees filing one or more pharmacy claim was 79.9% in 2014, 82.4% in 2015, and 83.1% in 2016. Those filing a pharmacy claim were significantly older and more likely women. Number of claims and total cost of claims increased with increasing baseline medical costs. Change in the number of claims and the total cost of claims is positive, increasingly so with poorer baseline medical costs. Age, sex, and wellness program points earned are not significant in the models. Conclusion: Wellness program participation decreases with age, is higher in women, and is greatest among those with moderate baseline medical costs. Number and cost of pharmacy claims is not associated with program participation. Change in number and cost of pharmacy claims is not associated with program participation.