Closing the Adherence Gap: Why Enrollment Isn't Enough

This article was sponsored by Pharmacy Quality Solutions

The data behind pharmacy adherence performance and what separates high-performing networks from the rest.

Enrollment isn’t the same as engagement.

Pharmacists see their patients more than almost anyone else in the healthcare system. A nationwide study of Medicare beneficiaries found that patients visited community pharmacies a median of 13 times per year, nearly twice the frequency of visits to a primary care physician. For patients managing diabetes, hypertension, or high cholesterol, the dispensing counter is often the most consistent clinical touchpoint they have.

That frequency should translate into better adherence outcomes. In many cases, it doesn't and new data from PQS by Innovaccer helps explain why.

The Data: A gap 15 to 21 percentage points wide.

Thousands of pharmacies participate in structured quality programs like LAMP (Longitudinal Adherence Monitoring Program), which connects pharmacists with the adherence data they need to support patients that have historically struggled with chronic disease medications. Participation matters. But, participation alone doesn't tell the whole story.

When PQS by Innovaccer analyzed year-end 2025 performance data across three PQA adherence measures: diabetes medications, RAS antagonists, and statins, a striking pattern emerged when looking at population adherence rates:

Population-level adherence scores representing the share of eligible members achieving sufficient days covered across the measurement year. Copilot n=937/1,231/1,569 across measures. All pairwise differences statistically significant (z > 7.6, p < 0.000001). Source: PQS by Innovaccer internal data, YE 2025.

Pharmacies using EQUIPP Copilot™ closed the year-end adherence gap at 1.5 to 2 times the rate of other program users. The difference was not clinical protocol. It was access to information at the moment it was needed.

What's driving the gap?

All three groups operated within the same quality program infrastructure and served comparable Medicare Advantage populations. The difference is information accessibility.

A pharmacist processing a maintenance refill is managing several things simultaneously: prescription verification, drug utilization review, counseling, transaction processing. Identifying an adherence opportunity in that context requires either that the relevant information is already in front of them, or that they stop what they're doing, navigate to a separate system, look up the patient, and then re-engage.

The behavioral research on context switching in high-demand clinical environments is consistent: tasks that require interrupting an existing workflow are performed inconsistently, and that inconsistency compounds over time. It is a predictable response to cognitive load.

The pharmacist who has to switch portals to find a quality opportunity will do so occasionally. The pharmacist for whom that information appears automatically will act on it routinely.

— PQS by Innovaccer Research Findings, YE 2025

What these numbers mean for patients.

Population-level adherence scores represent the share of eligible members achieving sufficient days covered across the measurement year. A 15 to 21 percentage point gain means a materially larger proportion of individual patients maintaining the consistent medication coverage that's directly associated with better outcomes in chronic disease.

In diabetes, that means sustained glycemic control and reduced risk of microvascular complications. In hypertension, it means blood pressure control and lower stroke risk. In cardiovascular disease, statin adherence is one of the most evidence-dense areas in pharmacology. Consistent use is associated with significant reductions in major adverse cardiovascular events and all-cause mortality in high-risk patients.

Brief gaps in therapy carry measurable cardiovascular risk. The adherence numbers in this data aren't performance metrics in isolation. They represent real clinical outcomes for real patients.

Intelligence where the work happens.

EQUIPP Copilot™ overlays any pharmacy management system without IT integration, API dependency, or workflow modification. When a pharmacist opens a patient profile in their native PMS, Copilot automatically surfaces that patient's adherence status, refill gap risk, program eligibility, and other care gap flags without a separate login or context switch.

Alerts for Final Fill timing, statin use care gaps and even extended day supply conversions surface at the moment the pharmacist is already engaged with that patient. Documentation of adherence counseling and care gap closure happens in structured fields aligned to PQA and NCQA specifications, at the point of intervention rather than retrospectively. Patient data refreshes weekly so pharmacists are always acting on current trajectories, not stale snapshots.

The broader program picture.

It's worth noting that EQUIPP Copilot™ users in this analysis represent a small share of the total LAMP-targeted patient population, approximately 0.4 to 0.5 percent, and these are early adopter pharmacies in a pre-scale deployment environment. The statistical significance of the results at this sample size reflects the magnitude of the performance difference, not sample depth. Longitudinal data at scale will be needed to assess how these results hold across more diverse network compositions.

What is clear from the broader LAMP program context: structured engagement moves patient outcomes. In the most recent full program year, year-over-year adherence improvement was recorded across all three measures: Diabetes up 2.7 percentage points, RAS Antagonists up 2.3, Statins up 3.5.

Read the complete findings.

This post covers the headline findings. The full white paper includes detailed statistical methodology, measure-level outcome analysis, clinical context for each drug class, and practical guidance for health plans and pharmacy organizations considering EQUIPP Copilot™ deployment.

If your pharmacies are enrolled in a quality program but do not see the adherence outcomes you'd expect, it's important the right information is present at the right moment.

Download the full report at www.pharmacyquality.com.