By Annie Schuster, PharmD, FAMCP
VP, Clinical Effectiveness & Stars Experience
For Medicare Advantage and managed Medicaid plans, diabetes medication adherence remains a key pharmacy quality measure that can influence Star and Quality Rating performance and member outcomes. Strong adherence performance is tied to better member outcomes, improved quality scores, and lower avoidable healthcare costs. Yet despite ongoing investments in adherence programs, many health plans continue to face challenges closing care gaps and improving performance among members living with diabetes.
Traditional adherence interventions often focus on reminders, outreach calls, and refill notifications. While these efforts are important, they frequently address the symptoms of nonadherence rather than the root causes.
The reality is that diabetes medication adherence is influenced by a complex combination of clinical, operational, financial, and behavioral factors. To meaningfully improve outcomes, health plans must look beyond refill reminders and adopt a more comprehensive medication management strategy.
Improving Diabetes Medication Adherence Through Proactive Refill Management
Many medication adherence programs are designed to identify members after concerning pharmacy claim patterns. By that point, a gap in treatment may have already occurred, potentially affecting both member health and quality measure performance.
One of the most common causes of medication nonadherence is a breakdown in the prescription renewal process. Delays in receiving provider authorization, expired prescriptions, denied refill requests, or communication challenges between providers, pharmacies, and patients can all lead to interruptions in therapy.
High-performing medication management programs focus on identifying these barriers before they impact the member. Proactive refill monitoring, ongoing outreach to prescribers, and patient engagement efforts can help close gaps before they occur.
In some states, emergency refill protocols allow a pharmacist to dispense a temporary medication supply while prescription issues are resolved, helping members avoid disruptions in therapy and maintain continuity of care.
For individuals managing chronic conditions such as diabetes, preventing a treatment gap may have an immediate health impact. It is important to prevent missing a day of medication, as well as encouraging the next refill.
How Coordinated Medication Management Supports Diabetes Adherence
Many individuals living with diabetes receive medications from multiple providers and often utilize more than one pharmacy.
While this may seem routine, fragmented medication management can create significant challenges for adherence. A newly prescribed therapy may be filled locally while maintenance medications continue through another pharmacy. Over time, medication synchronization becomes more difficult, increasing the likelihood of missed refills, duplicate therapies, or incomplete medication reviews.
For pharmacies focused on improving diabetes medication adherence, visibility is critical.
When a pharmacy has a comprehensive view of a member’s medication regimen, clinical teams are better positioned to assess reasons for refill gaps, coordinate refill schedules, educate on the importance of the medication as well as the negative effects of long-term uncontrolled diabetes, encourage blood glucose home testing, and proactively address potential gaps in therapy. This coordinated approach also supports more comprehensive medication reviews and stronger collaboration with providers, especially when changes to optimize therapy regimens are necessary.
As populations become increasingly complex, coordinated medication management can play an important role in improving both member experience and quality performance.
Addressing Affordability Barriers to Improve Medication Adherence
Affordability remains one of the most significant yet under-appreciated drivers of medication nonadherence.
This challenge is particularly important in diabetes populations, where adherence measures frequently include members taking higher-cost brand medications, including GLP-1 receptor agonists and SGLT2 inhibitors. While these therapies have transformed diabetes care for many patients, out-of-pocket costs can create barriers that traditional adherence outreach efforts alone cannot solve.
Members facing affordability challenges may delay refills, skip doses, or discontinue therapy entirely.
In these situations, the issue is not a lack of engagement. It is a lack of access.
Organizations that consistently improve diabetes medication adherence often incorporate affordability discussions into their outreach and medication management programs. Understanding whether members can realistically obtain and maintain prescribed therapy is a critical component of long-term adherence success.
Addressing cost-related barriers frequently requires collaboration among pharmacists, providers, patients, and health plans to identify clinically appropriate and financially sustainable solutions.
As healthcare costs continue to rise, affordability must be viewed as both a member challenge and a quality improvement opportunity for pharmacies and health plans.
The Role of Clinical Pharmacy Interventions in Diabetes Care
Medication adherence and clinical optimization are often discussed separately, but in reality, they are deeply connected.
Not every member with uncontrolled diabetes is struggling because they are failing to take medications as prescribed. In many cases, existing therapy may no longer be sufficient to meet the patient’s clinical needs.
Clinical pharmacists play an important role in identifying these situations.
Through ongoing medication reviews and patient engagement, pharmacists may recognize opportunities for therapy optimization, additional patient education, or provider collaboration. Members experiencing persistent hyperglycemia, medication-related concerns, or treatment challenges can benefit from interventions that extend beyond simple adherence outreach.
These clinical touchpoints help ensure that members are not only taking medications consistently but also receiving the most appropriate therapy for their concurrent conditions.
For health plans focused on population health management, pharmacy teams can serve as valuable clinical partners in supporting quality improvement initiatives, reducing care gaps, and improving outcomes among members with diabetes.
A More Comprehensive Approach to Diabetes Medication Adherence
The healthcare industry has made significant progress in understanding medication adherence, but success requires a broader perspective.
Improving diabetes medication adherence involves much more than reminding members to refill prescriptions. Sustainable results depend on addressing the interconnected factors that influence treatment success, including:
- Prescription access and refill management
- Medication affordability
- Care coordination
- Provider collaboration
- Clinical optimization
- Member engagement and education
Health plans that consistently improve adherence performance are often those that recognize medication management as a comprehensive, ongoing process rather than a series of isolated interventions.
As quality expectations continue to evolve and organizations focus on improving outcomes across Medicare Advantage and managed Medicaid populations, the ability to address the root causes of nonadherence will become increasingly important.
The future of diabetes medication adherence is not simply about filling prescriptions. It is about creating connected, patient-centered systems that proactively identify barriers, educate and support members through challenges, and ensure access to appropriate therapy.
When adherence is approached as a comprehensive medication management strategy, health plans can improve quality performance, close care gaps, strengthen member outcomes, and create lasting value across their populations.
