Why $0 Copays Often Cost Less: Medication Adherence as Preventive Medicine

Why $0 Copays Often Cost Less

Medication adherence as preventive strategy

Most employers are conditioned to view pharmacy benefits as a cost to manage down. Copays are one of the most visible levers, so the default assumption is straightforward: if members pay more at the pharmacy counter, the plan spends less.

In practice, the opposite frequently occurs.

When out-of-pocket costs rise, many people delay starting therapy, skip refills, split doses, or abandon prescriptions altogether. A meaningful share of prescriptions are never filled, and long-term adherence for chronic conditions remains persistently low. Nonadherence is widely associated with higher rates of avoidable complications, hospitalizations, and downstream medical utilization.

This is not a marginal issue. It is one of the most consistent drivers of avoidable healthcare spend across employer plans.

Cost sharing and the adherence tradeoff

Across disease states and demographics, research shows a consistent pattern: as member cost sharing increases, medication adherence and persistence decline. This relationship has been observed in conditions such as cardiovascular disease, diabetes, asthma, and mental health, regardless of drug class or delivery channel.

For employers, reduced adherence rarely represents true savings. More often, it shifts cost from the pharmacy benefit to the medical side of the plan.

Poorly controlled blood pressure is associated with higher rates of stroke and heart failure. Inadequately managed diabetes is associated with complications that drive emergency care and inpatient admissions. Gaps in mental health treatment are associated with higher utilization during periods of crisis. In each case, short-term reductions in pharmacy spend may coincide with higher total cost of care over time.

What changes when cost barriers are removed

When financial barriers are reduced, the pattern frequently moves in the opposite direction. Studies of value-based insurance design and copay reductions show that lower or eliminated copays for certain medications are associated with higher fill rates and improved persistence on therapy.

In real-world employer populations, copay elimination for selected medications has been associated with improved adherence and, in some cases, more stable overall cost patterns for those members. Medical claims may decline for some populations, particularly in high-cost categories such as inpatient admissions and emergency visits. While results vary by population, condition, and plan design, the underlying dynamic is consistent.

Lower cost at the pharmacy counter reduces friction. More members initiate therapy and remain on treatment for chronic conditions such as hypertension, diabetes, and hyperlipidemia. Better adherence is associated with improved disease management and fewer avoidable escalations of care.

Pharmacy spend may increase for adherent members. At the same time, employers may see reduced volatility in medical claims driven by fewer acute events and interruptions in care. In this context, pharmacy dollars function less as a sunk cost and more as a stabilizing input to overall plan performance.

$0 copays as a strategic design choice

Prescription medications will remain a significant component of employer healthcare spend. The question is not whether employers will pay for medications, but whether those dollars are deployed in a way that supports consistent use and more predictable outcomes.

Zero-copay designs are not a giveaway. They are a structured approach designed to reduce barriers that are associated with avoidable complications and acute care utilization, while aligning pharmacy benefits with broader cost-management and population-health objectives.

How Aphora Health fits

Aphora Health supports $0 copay benefit designs focused on improving medication access and adherence, implemented alongside an employer’s existing pharmacy and medical benefit structure. Aphora is designed to complement, not replace, current plans.

Importantly, Aphora can be implemented at any time of year. Employers do not need to wait for open enrollment or a plan-renewal cycle. Aphora is typically offered as a voluntary benefit, allowing eligible employees to opt in when they choose, with enrollment available year-round.

This approach gives employers flexibility. They can introduce Aphora off-cycle, target specific populations or medications, and begin supporting adherence without disrupting existing benefit elections or carrier relationships.

If you are a self-insured employer or broker looking to improve medication adherence without waiting for renewal season, you can learn more about implementing Aphora Health as a voluntary option at any time: https://aphorahealth.com/contact-us

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