| Large employers in the United States have experienced year-over-year increases in health care costs and have implemented different management strategies in an effort to change employee behavior to reduce costs. The problem examined in the study was the Step Therapy Pharmacy Program was frequently used as a strategy to change participant behavior to lower pharmaceutical costs without any evidence the program creates lasting behavioral change. The purpose of the quantitative interrupted time series quasi-experimental study was to use archived data to examine the entire population of a large nationwide U.S. Fortune 500 company over 2 years at monthly intervals, to include the 12 months before and the 12 months after implementing a Step Therapy Pharmacy Program (IV) to determine what, if any, difference the program has on Step 1(DV1), Step 2 drug use (DV2) and pharmaceutical costs of program drugs (DV3). The results of the study provide insight into other applications of the theory of planned behavior and health belief model for participant engagement using similar restricted benefits rather than financial incentives or penalties, which do not create lasting change in individual behavior. The analysis indicated an increase in Step 1 drug utilization after the Step Therapy Pharmacy Program was implemented within the anticonvulsant (Z = -3.07, p = 0.002), multiple sclerosis (Z = -2.86, p = 0.004), and sleep aid (Z = -2.32, p = 0.020) therapeutic classes. Results also indicated increased Step 2 drug utilization after the Step Therapy Pharmacy Program was implemented within the anticonvulsant (Z = -2.04, p = 0.042) and multiple sclerosis (Z = -2.71, p = 0.007) therapeutic classes. The increase in Step 2 utilization led to increased Step 2 costs within the anticonvulsant (t = -4.53, p = 0.001) and multiple sclerosis (Z = -2.53, p = 0.011) classes after the program was implemented, which would not have been predicted according to the theory of planned behavior and health belief model. The researcher concluded the Step Therapy Pharmacy Program definitively increased Step 1 and Step 2 drug utilization, both supporting and refuting predications applying the theory of planned behavior and health belief model. Future research on the theory of planned behavior and health belief model may need to more closely examine why drug utilization within two therapeutic classes could not be predicted. Future research on the Step Therapy Pharmacy Program's ability to influence lasting behavioral change should focus on specific therapeutic classes driving pharmaceutical costs. |
