OBJECTIVES : To improve medication adherence, Blue Cross Blue Shield of Louisiana (BCBSLA) rolled out a Zero Dollar Co-pay (ZDC) program that eliminated co-pays for a large set of medications related to chronic diseases in January 2015. The purpose of this research is to determine whether the ZDC program affected health care utilization and spending.

METHODS : The study population included all BCBSLA members who actively enrolled in the disease management (DM) program between January 1, 2015 and April 30, 2018 and who subsequently joined the ZDC program. Additional inclusion requirements include: 1) members must be part of the DM program for at least 6 months, 2) members must be part of the DM program for at least one month prior to joining the ZDC program; 3) members must have at least one month of claims following ZDC enrollment; and 4) members must be older than 18 years. Members who did not take ZDC related drugs were excluded. We also excluded members with no pharmacy co-pay plan or other waiving copay benefits. Multivariable models incorporated time fixed effects, members fixed effects and an indicator for ZDC participation (the indicator switches on the first month the member is eligible for a zero co-pay). Additional control variables included the number of nurse calls.

RESULTS : Participants: 249 patients actively engaged in the DM program and enrolled in the ZDC program at some point between March 2015 and April 2018. The ZDC program decreased member PMPM total spending by $292.2 (p-value <0.001) or by approximately 20% of total spending. The decrease in total spending was due in equal proportion to decreases in medical and pharmacy PMPM spending, -$216.4 and -$68.2, respectively.

CONCLUSIONS : The ZDC program is effective in reducing healthcare utilization and PMPM spending.