OBJECTIVES: To evaluate the effectiveness of the zero dollar copay disease management (ZDC) program for patients with chronic diseases who are Blue Cross Blue Shield of Louisiana (BCBSLA) members. The ZDC program is an incentive program implemented in conjunction with disease management and provider engagement. The ZDC program offers $0-copays for generic drugs to treat the following chronic conditions: diabetes, heart disease, hypertension, lung conditions (e.g. asthma), and mental health conditions.

METHODS: In-state BCBSLA members enrolled and actively engaged in a disease management program from January 1, 2015 – June 30, 2017 were eligible for inclusion. Members also needed: a record of 9-month pre- or post-plan enrollment; 9 months of pre- or post-program enrollment; and copay prescription coverage from ZDC participation (treatment) or disease management programs (control). A weighted propensity score was generated to adjust for differences in baseline characteristics between ZDC members and their controls. Annual healthcare utilization and per member per month (PMPM) expenditures were compared between the 2 groups using multivariable regression modeling.

RESULTS: Of the 881 patients who met all inclusion criteria, 632 (71.7%) were assigned to the ZDC group and 249 (28.3%) were assigned to the control group. Both groups showed an increased number of scripts (brand and generic); however, the ZDC group had a larger increase in total scripts than the control group (P<0.0001). After model adjustments, members in the ZDC program trended toward better medication adherence for antihypertensives, antihyperlipidemics, antidiabetics, calcium channel blockers and diuretics; and a significant decrease in annual all-cause admissions (19/1000), avoidable admissions (20/1000), and 30-day readmissions (6/1000). PMPM savings are possible ($28 in prescriptions and $237 in medical).

CONCLUSIONS: The ZDC program is effective in increasing medication adherence and reducing healthcare utilization and is a great example of how effective population health-management techniques can lower the disease burden of chronic conditions.