Medication adherence data tells health plans what is happening. It rarely tells them why.
A missed refill can look simple on a report. Look closer, and it is often something else entirely: a cost worry, a language gap, a broken-down car, or confusion about a new prescription. These barriers are real, and they are common among the sociodemographic populations now central to Star Ratings success.
At ActualMeds, our clinicians hear these stories every day. Here are three and how we helped.
When Cost Is the Real Barrier
A hearing-impaired member relied on a sign language interpreter to talk with our team about his statin and blood pressure medication. He had stopped picking up his prescriptions. He was worried about the cost.
Our clinician confirmed something simple but important: he had a zero-dollar copay on both maintenance medications. Once he heard that, he agreed to fill them right away.
The barrier was never his hearing. It was a cost concern nobody had addressed.
When a New Medication Needs an Explanation
A Spanish-speaking member had been prescribed a new diabetes medication by a hospitalist. She was not sure why she needed it or how it fit into her care.
Our pharmacist called and explained it to her in Spanish which built trust. He answered her questions and encouraged her to follow up with her primary care provider. She filled the prescription within two days of that first call.
Sometimes the barrier is not access. It is understanding.
When a Missed Appointment Hides a Bigger Problem
A member missed a refill of her metformin. Her pharmacy said the prescription had no refills left. Our pharmacist called her provider, who said something surprising: the member was no longer a patient there.
The member had missed too many appointments because she didn’t have reliable transportation to her appointments, not because she didn’t want to see the doctor. In fact, she had no idea her provider had dropped her.
Our SDOH clinician connected her with transportation services through her plan. She returned to her original provider, who refilled her medication.
What These Stories Have in Common
None of these members needed a lecture about adherence. They needed someone to listen, dig a little deeper, and solve the actual problem in front of them.
That is the work behind the numbers that the ActualMeds team understands deeply. It is work that takes clinical knowledge, patience, and a team that treats every call as a chance to remove one more barrier between a member and their health.
This is what ActualMeds does at scale, one member and one story at a time. If your plan is looking for a partner who brings this same approach to your highest-risk populations, we would love to talk.