Winberg Debra, Nauman Elizabeth, Shi Lizheng, Mohundro Brice L, Louis Kelly, Price-Haywood Eboni G, Tang Tiange, Bazzano Alessandra N
School of Public Health and Tropical Medicine, Celia Scott Weatherhead School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St, New Orleans, LA, 70112, United States of America.
Louisiana Public Health Institute, New Orleans, United States of America.
Health Res Policy Syst. 2025 Jan 6;23(1):6. doi: 10.1186/s12961-024-01278-5.
Type 2 diabetes mellitus (T2D) remains a pressing public health concern. Despite advancements in antidiabetic medications, suboptimal medication adherence persists among many individuals with T2D, often due to the high cost of medications. To combat this issue, Blue Cross and Blue Shield of Louisiana (Blue Cross) introduced the $0 Drug Copay (ZDC) program, providing $0 copays for select drugs. This study sought to explore barriers and facilitators to the successful implementation of Blue Cross's ZDC program (updated version).
Focus group discussions and interviews were conducted with health plan leadership, health coaches and providers who participate in the health plan organization's healthcare quality improvement program. Focus group discussions and semi-structured interviews were conducted between October 2022 and July 2023. Discussion guides were developed collaboratively and tailored to each participant group. Interviews were recorded, transcribed and analysed using NVivo qualitative analysis software. A descriptive, qualitative analysis was conducted, resulting in the identification of seven codes and subsequent candidate themes.
In total, 15 participants were interviewed: 6 were Blue Cross administrators, 5 were health coaches and 4 were Quality Blue providers. Overall, participants had positive feedback on the ZDC program and perceived that it has significant benefits for patients and the health system but could be improved, and four themes related to implementation barriers and facilitators, effectiveness and potential areas of improvement were identified: (1) the ZDC program reduces friction for patients, prescribers and the health system; (2) the program is aligned with the values of health systems, insurers and providers, facilitating implementation success; (3) expanding coverage (drug classes and conditions) and education (for providers and patients) could maximize program benefits; and (4) coronavirus disease 2019 (COVID-19) did not negatively impact program administration because the $0 copay was programmed at the benefit level.
The ZDC program aligns goals and can benefit patients, providers and patients. The program can have the largest potential if it is expanded to include new medications and new conditions, and if there is more education for patients and providers. Regardless of challenges, reduced-copay programs have the potential to improve medication adherence, improve HbA1C control and improve overall health outcomes. Trial Registration This study was approved by the Tulane University Institutional Review Board, IRB #2020-1986.
2型糖尿病（T2D）仍然是一个紧迫的公共卫生问题。尽管抗糖尿病药物有所进步，但许多T2D患者的药物依从性仍不理想，这通常是由于药物成本高昂。为了解决这个问题，路易斯安那州蓝十字蓝盾公司（蓝十字）推出了零药费共付（ZDC）计划，为选定药物提供零共付费用。本研究旨在探讨成功实施蓝十字ZDC计划（更新版）的障碍和促进因素。
对参与健康计划组织医疗质量改进计划的健康计划领导层、健康教练和提供者进行了焦点小组讨论和访谈。焦点小组讨论和半结构化访谈于2022年10月至2023年7月进行。讨论指南是共同制定的，并针对每个参与群体进行了调整。访谈进行了录音、转录，并使用NVivo定性分析软件进行了分析。进行了描述性定性分析，确定了七个编码和随后的候选主题。
总共采访了15名参与者：6名是蓝十字管理人员，5名是健康教练，4名是优质蓝十字提供者。总体而言，参与者对ZDC计划给予了积极反馈，并认为该计划对患者和卫生系统有显著益处，但仍有改进空间，确定了与实施障碍和促进因素、有效性及潜在改进领域相关的四个主题：（1）ZDC计划减少了患者、开处方者和卫生系统的阻力；（2）该计划与卫生系统、保险公司和提供者的价值观一致，促进了实施的成功；（3）扩大覆盖范围（药物类别和病症）和教育（针对提供者和患者）可以使计划效益最大化；（4）2019冠状病毒病（COVID-19）对计划管理没有负面影响，因为零共付费用是在福利层面设定的。
ZDC计划目标一致，对患者、提供者和卫生系统都有益处。如果该计划扩大到包括新药物和新病症，并且对患者和提供者进行更多教育，其潜力将最大。无论面临何种挑战，降低共付费用计划都有可能提高药物依从性、改善糖化血红蛋白（HbA1C）控制并改善整体健康结果。试验注册 本研究获得了杜兰大学机构审查委员会的批准，IRB编号为#2020-1986。
