OBJECTIVE: The objective was to investigate the compliance and expenditure impact of pharmacist’s cognitive services (i.e. services that require clinical skills, such as patient education). METHODS: Data come from the Cognitive Activities and Reimbursement Effectiveness Project (CARE), and Washington State Medicaid. There were three groups of pharmacies; a group that was paid to provide cognitive services (n=110), a group that was not paid but did document the provision of cognitive service (n=90), and a control group (n=100) matched to patients in the paid and nonpaid groups. Data was collected for six months of both baseline and follow-up. There were 992 patients from the paid group pharmacies, 554 from the nonpaid and 6,021 from the control group. The outcomes of interest were 1) medication noncompliance 2) utilization of services, and 3) expenditures. The analysis focused on 7 target diseases (epilepsy, depression, heart disease, thrombolic disease, hypertension, diabetes and schizophrenia). RESULTS: The paid and nonpaid groups were 31% less likely to be noncompliant (OR=0.69; 95% CI 0.51, 0.94) than the control group. The likelihood of noncompliance decreased with increasing numbers of services per patient. Total cost was not significantly increased (p>0.05) for the paid or nonpaid group. There was an increase in prescription cost and use for target diseases in the paid and nonpaid group (p<0.05), but there was a contemporaneous trend (p>0.05) toward decreased cost of other components of care. CONCLUSION: Paying for cognitive services may be cost neutral overall, while increasing the likelihood of favorable clinical outcomes through gains in medication compliance.