Blue Cross’ $0 drug copay program lowers total healthcare spending

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BATON ROUGE – A Blue Cross and Blue Shield of Louisiana program to improve medication adherence by making select drugs available at $0 for members with chronic conditions led to significant declines in total healthcare spending, according to Blue Cross research recently published in the American Journal of Managed Care.

Blue Cross designed its $0 Drug Copay program to focus on encouraging and supporting members with certain chronic diseases, including depression, in sticking to their prescribed medications.

Because cost is a common reason people do not take medication as directed, the program removed out-of-pocket costs by providing members a widely used set of medications to treat their conditions for a $0 copay.

“Our $0 Drug Copay program achieved something unusual in healthcare – it enhanced patient access to medications and reduced total healthcare spending significantly after members enrolled in this program,” said Somesh Nigam, chief analytics and data officer at Blue Cross and Blue Shield of Louisiana. “The decrease was primarily in medical spending rather than pharmacy spending.”

Not taking needed medicines for chronic health problems can be dangerous and cause lasting health damage. It also is a significant factor contributing to the high clinical and economic costs of chronic disease, the Blue Cross researchers wrote in the recent paper “Value-Based Insurance Design in Louisiana: Blue Cross and Blue Shield’s Zero Dollar Co-pay Program.”

Patients enrolled in the $0 Drug Copay program, which began in 2014, were associated with an 18% decrease in total spending. (Previous studies have shown that eliminating pharmacy copays led to patients being more likely to take medication as directed, but no change in total spending.)

“We want to remove barriers that keep people from taking needed medicines,” says Milam Ford, Blue Cross vice president of Pharmacy Services. “With the $0 Drug Copay Program, many of our members can get drugs in the program without worrying about the cost.”

Drugs in the $0 Drug Copay Program are regularly recommended to treat asthma, chronic obstructive pulmonary disease (COPD), coronary heart disease, diabetes, heart failure and other common chronic conditions. Blue Cross identified a set of high-volume, low-cost medications for each relevant drug class and reduced the copay to $0.

As Blue Cross has learned more about the program benefits, it has expanded the program several times.

The $0 Drug Copay Program is now available for most members whose health plans have copays for prescription drugs and who get their pharmacy benefits through Blue Cross or HMO Louisiana, Inc. Members do not have to meet their deductibles before getting drugs covered in the program for $0.

The program is not available for coinsurance-only pharmacy benefits. Members may go to bcbsla.com/covereddrugs for a list of drugs in the program. To find out if they have an eligible plan, members may call the Customer Service number on their ID cards.

Blue Cross research on the $0 Drug Copay program also has been published in 2018, 2019 and 2020 in Value in Health, the international journal that publishes research and health policy articles on health economics and outcomes research.

Copyright 2020 Nexstar Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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