Essential Insights 

• Close refill gaps: Helped reduce disruptions in ongoing medication therapy.
• Data-driven outreach: Proactive outreach supported 90-day prescription adoption.
• $149M annual avoidance: Generated an estimated $149 million in annual cost avoidance.

The Big Picture

One of the nation’s largest Medicare Part D plans needed to improve medication adherence across its member population to reduce gaps in prescription refills, improve outcomes, lower avoidable costs, and support performance on CMS Star Ratings measures.

The plan partnered with Carenet Health to launch a proactive, data-driven outreach initiative. The effort used one-to-one conversations to help members at risk of non-adherence transition to a 90-day supply of maintenance medications.

The program achieved a strong member engagement rate and generated an estimated $149 million in annual cost avoidance.

Plan leaders credited the program as a key contributor to improved medication adherence performance and the plan’s overall 4-Star rating.

Challenge

Costs were rising, quality performance was at risk, and members’ health was on the line.

Medication non-adherence was a critical concern for this large Medicare Part D plan, especially among members managing chronic conditions such as hypertension, cardiovascular disease, and diabetes. Even short interruptions in medication therapy can contribute to life-threatening side effects, treatment failures, and preventable hospital admissions. The economic impact is also significant, with the cost of non-adherence ranging from $1,300 to more than $55,000 per person.

Non-adherence also affects CMS Star Ratings, making medication adherence a key quality lever tied to pharmacy measures and overall plan performance.

Plan leaders needed a cost-effective way to educate members on the importance of staying on therapy and help them transition to a convenient, cost-saving 90-day supply option, supported by live, compliant member engagement.

The plan partnered with Carenet Health to deliver that solution through proactive, one-to-one outreach.

Key Challenges

• Challenge 1: Improve medication adherence
• Challenge 2: Reduce prescription refill gaps
• Challenge 3: Support CMS Star Ratings performance

Solution 

Data-driven engagement helps prevent non-adherence before it starts.

Rather than waiting for refill gaps to emerge, the plan and Carenet developed a proactive outreach strategy focused on members showing signs of future non-adherence. The program identifies members with inconsistent refill patterns, often an early indicator of longer-term adherence risk. •

• Targeting is based on members’ medication regimens and refill history, identifying those who previously filled 90-day prescriptions but have since shifted back to 30-day refills, as well as those who have never enrolled in a 90-day program. •
• One-to-one live outreach occurs well before the next refill is due, helping prevent gaps in medication access and delivery. •
• Experienced Health Advisors tailor each conversation to the member’s needs and medication profile, offering the option to switch to a 90-day supply and reinforcing the benefits of adherence. When appropriate, members can be seamlessly connected to their preferred pharmacy to complete the transition.
• The team is trained in Medicare Part D, effective engagement techniques, and delivering a high-quality, member-centered experience for older adults.

Results

The custom medication adherence program proved so effective that it expanded to additional member populations.

• Generated an estimated $149 million in annual cost avoidance.
• Maintained an average engagement rate of 81% across the multi-year program.
• Increased program scale by 30%, expanding outreach to additional member populations.
• The Medicare Part D plan credited the program as a key contributor to its medication adherence performance and overall 4-Star rating.