2026 Southeastern Residency Conference

Title: Impact of Health-System Community Pharmacists on Adherence for Medicare Advantage Plan Members 
Primary Author: Heather Vance 
Co-Authors: Catie Harper 
Practice Site: Cone Health Community Pharmacies and Triad HealthCare Network
Background: 
The Centers for Medicare and Medicaid Services (CMS) indicates quality of Medicare plans using a star-rating system, with one being the lowest and five being the highest. Three of the measures included in the star-rating system relate to patient medication adherence, including medication adherence to statins. CMS defines adherence as a proportion of days covered (PDC) of 80% or more.
Cone Health participates in value-based care agreements with payers to improve the quality of care provided to patients. Additionally, Cone Health sponsors a Medicare Advantage plan with Part D prescription drug coverage.
Through continuous evaluation, our organization identified that patients using integrated health-system pharmacies had improved medication adherence compared to outside pharmacies. Proactively, Cone Health began targeting patients failing or at risk of failing the statin adherence measure using health-system pharmacies to characterize the impact of targeted community-pharmacist intervention on plan member adherence.
Methods: 
This is an IRB reviewed, determined exempt, retrospective pre-post study evaluating medication adherence among members of a Medicare Advantage plan. Included patients were active plan members in 2025, with one or more statin fills at an integrated pharmacy, with Medication Adherence for Cholesterol measure PDC of 85% or less through the end of July 2025, identified through reports provided by the plan. Excluded patients were deceased, filling at non-health-system pharmacies, transitioned to hospice, or had therapy discontinued by their provider. The percentage of patients with PDC > 80% pre-intervention compared to post-intervention was the primary outcome, evaluated with McNemar’s Test. The number/type of pharmacist intervention was the secondary outcome, evaluated with descriptive statistics.
Patients received telephonic and electronic communication from the primary investigator regarding their prescribed statin therapy. After 3 unsuccessful attempts, patients were considered lost to follow-up. An adherence interview was conducted to assess understanding, tolerability, need for referral, and barriers to adherence. Patients were enrolled in appropriate adherence services. After enrollment, patients were contacted before their next refill to ensure sustained adherence.
Results: 
Of the 53 eligible patients, 19 patients were excluded. At baseline, the average age was 73.7 years, 50% of patients had clinical ASCVD, 55.9% had an LDL < 70 mg/dL, 50% had a PDC score of 65-79.9%, and 26.5% with PDC < 65%.
At baseline, 23.5% (n = 8) patients were considered passing the MAC measure with a PDC score > 80% compared to 41.2% (n = 14) after study completion. Of these patients, 7 were initially failing the MAC measure at baseline and were converted to passing. The final percentage of patients failing the MAC measure after study completion was 58.8% (n = 20), 19 of which were initially failing at baseline.
A total of 73 interventions were completed over the course of this study, with 53 conducted in the PDC < 80% group. The most common intervention was refilling other medications (n = 24), refilling targeted medication (n = 13), and leaving a voicemail with returned call (n = 13). The most common adherence service provided was automatic-refill enrollment (n = 5).
Conclusions: 
There was not a statistically significant difference between PDC scores among patients during pre- and post-intervention. This study encouraged the development of an adherence monitoring platform to ease monitoring and intervention for population health pharmacists. In the future, a single investigator driven intervention may not be sufficient to improve patient adherence, especially among larger cohorts.