Purpose: Programs enlisting multiple techniques, including copay incentives, have shown increased medication adherence, improved outcomes and reduced overall healthcare costs. The purpose of this study was to evaluate a diabetes care management program using copay waivers for diabetes medications and supplies implemented by a southeastern health plan for a local government group in May 2005.

Method: Invited to join were 248 employees, spouses and dependents diagnosed with Type I or II diabetes. Of those, 109 enrolled (44%). Participation involved attending educational programs and physician consultations as well as routine HbA1c evaluations. Medical and pharmacy data were examined for differences in adherence to medication and healthcare screenings for participants and nonparticipants.

Analyses included 51 participants and 125 nonparticipants who were continuously enrolled in the health plan for 16 months. Medication adherence, the ratio of supply days to days in the study period, was assessed at three time periods—four months prior to (baseline) and at six-month intervals after the program start. Treatment compliance was calculated as the number of American Diabetes Association recommended procedures (available in claims data) received within a year of the program start. Scores included 2 HbA1c tests, 1 eye exam, 1 lipid screening, and 1 microalbuminuria screening.

Results: Average treatment compliance scores were significantly higher (p< .0001) for participants than nonparticipants (4.2 to 3.0, respectively). Average nonparticipant medication compliance ratios were stable at 0.45, which is significantly lower than ratios for participants (p< .0001), ranging from 0.93 (baseline) to 1.00 (after 1 year). Examination of pharmacy claims revealed increasing costs for participant medications despite maintaining relatively stable medication adherence. This increase may be explained by a significant (p < .10) shift from generic to brand medications after program implementation—a pattern not seen in the nonparticipant group.

Conclusions: Results support assertions for the benefits of care management programs as participants received more health screenings and maintained high diabetes medication adherence. Findings can be used to better predict impact on healthcare costs when implementing similar programs.