Medicare Part D Adherence Programs: A Marketing Playbook

Nearly half of patients with chronic conditions do not take their medications as prescribed, and for a Medicare Part D plan, that gap shows up directly in its Star Rating. RevealSite's pharmacy marketing services exist because the pharmacies that close that gap first tend to win the preferred-network conversations later. A Medicare Part D adherence program gives your pharmacy a structured way to raise the proportion of days covered for diabetes, hypertension, and statin medications instead of hoping refills happen on their own.

This playbook walks through the measures CMS tracks, which patients to target first, how to build the program operationally, and how to market it so patients actually show up. You will also see the metrics that prove it is working.

What Are Medicare Part D Adherence Measures, and Why Do They Matter to Your Pharmacy?

Medicare Part D adherence measures track the proportion of days covered, or PDC, for three drug classes: diabetes medications, RAS antagonists for hypertension, and statins. A patient counts as adherent only if they have medication on hand at least 80% of the days in a measurement year.

These three PDC measures are triple-weighted in the CMS Star Ratings program that scores every Medicare Advantage and Part D plan. Plans lean on pharmacies to move that number because a pharmacy dispensing thousands of prescriptions a year has more contact with patients than the plan itself ever will. Almost 50% of patients with chronic conditions do not take medications as prescribed, a gap the National Institutes of Health ties to roughly $528 billion a year in avoidable complications and hospitalizations nationwide.

For an independent pharmacy, that statistic is an opening. A plan that sees your store consistently improving PDC has a reason to keep you in its preferred network, and a reason to send you more of its members.

How Do CMS Star Ratings Affect Your Pharmacy's Bottom Line?

CMS Star Ratings determine bonus payments to Medicare Advantage plans, which gives plans a direct financial reason to reward pharmacies that improve adherence. A plan earning a 5-star rating receives higher reimbursement, and it passes some of that pressure downstream to its pharmacy network.

What Changed With Part D DIR Fees in 2024?

The stakes for independent pharmacies rose further when Part D direct and indirect remuneration, or DIR, fees moved to point-of-sale beginning January 1, 2024. According to the Centers for Medicare & Medicaid Services, that shift created a cash-flow shock as 2023 retroactive fees and 2024 reductions landed at the same time. Margins on Part D claims are thinner than they used to be. Pharmacies that can point to measurable adherence performance have a stronger negotiating position than those that cannot.

None of this means your pharmacy negotiates Star Ratings bonuses directly with CMS. It means the plans you fill prescriptions for have every incentive to notice which pharmacies are moving PDC and which are not.

• Higher Star Ratings unlock quality bonus payments for the plan, not the pharmacy directly
• Plans increasingly steer preferred-network status toward pharmacies with strong adherence data
• Point-of-sale DIR fees make consistent, documented performance more valuable at renewal time

Which Patients Should You Target First?

Target patients on diabetes, hypertension, or statin therapy who have a recent missed refill, plus anyone managing four or more chronic medications. These polypharmacy patients carry the highest risk of dropping below the 80% PDC threshold plans track every year.

Chronic disease prevalence gives you a rough sense of scale. The CDC estimates 40.1 million Americans have diagnosed or undiagnosed diabetes, and separate CDC data puts hypertension at 48.1% of adults, with only about 22.5% of those cases controlled. Add high cholesterol, present in roughly 11.3% of adults, and most Medicare patients on your shelves fall into at least one of the three PDC classes.

Not every patient in those categories needs the same level of outreach. A patient who fills every prescription on time doesn't need a phone call. Save your staff time for the ones with a gap.

How to Prioritize Outreach

Building the Program: Med Sync, Refill Reminders, and MTM

Build a Medicare Part D adherence program around three operational tools: medication synchronization, automated refill reminders, and medication therapy management. Together, they close most of the gaps that drag down PDC scores without adding much manual work per patient.

Medication synchronization aligns every chronic prescription to one monthly pickup date, which turns a scattered refill schedule into a single, predictable touchpoint. For a deeper look at candidate selection and staff workflow, RevealSite's medication synchronization guide covers the full rollout.

Refill reminders, whether by text, call, or app, catch the patients who are not yet on sync.

Medication therapy management sessions give pharmacists a scheduled reason to review the full regimen and catch adherence barriers, such as cost or side effects, before they turn into a lapsed fill.

81% of independent pharmacies already offered MTM services in 2024, according to the NCPA 2024 Digest, so the infrastructure most pharmacies need already exists. The work is connecting it to a documented adherence workflow instead of running it as a separate service line.

A Simple Rollout Workflow

1. Identify PDC-eligible patients through your dispensing software's therapy class filters
2. Offer medication synchronization at the next fill for anyone with 2 or more chronic scripts
3. Set automated refill reminders for patients who decline sync
4. Schedule an MTM review for anyone with a missed refill or a new diagnosis in a PDC class
5. Log each intervention so you can report improvement to plans at renewal

How Should You Market an Adherence Program to Patients?

Market a Medicare Part D adherence program around convenience and health outcomes, never around enrollment counts or plan performance. Patients respond to fewer trips and one pickup date, not to the fact that your pharmacy is trying to move a Star Rating.

Timing matters as much as messaging. Medicare's fall open enrollment window puts adherence and plan benefits on patients' minds already, which makes October through December a natural stretch for adherence outreach alongside the seasonal campaigns covered in RevealSite's Medicare open enrollment marketing guide. Outside that window, keep messaging steady through refill reminder texts, brief counter conversations at pickup, and simple print materials near the register. If your pharmacy sends appointment or refill texts, confirm your 10DLC registration is current so those messages actually deliver.

Keep the language plain. "Let's get your refills on one schedule" works better than anything that sounds like a compliance program, because to the patient, it should feel like one.

What Should a Refill Reminder Actually Say?

A good refill reminder names the medication category, states the pickup window, and gives one clear action. It does not need to mention Medicare, Star Ratings, or PDC at all. Consider the difference between two texts a patient on hypertension medication might receive.

• Weak: "Your prescription is due. Please refill soon."
• Stronger: "Hi [name], your blood pressure medication is ready for pickup through Friday. Reply CALL if you'd like us to sync it with your other refills."

The second version does three things at once. It names the medication in plain terms, gives a deadline, and opens the door to medication synchronization without asking the patient to understand what that phrase means. Caregivers of older adults on multiple medications respond especially well to this kind of specificity, since they are often coordinating refills for someone else.

What Metrics Prove the Program Is Working?

Track PDC by drug class, 30-day refill rate, and patient retention across two to three quarters to prove an adherence program is working. A single month of data will not show much, since PDC is a rolling annual measure by design.

Watch for a rising PDC alongside a stable or growing prescription count. That combination shows the program is closing real gaps rather than simply shuffling patients who were already adherent into a new workflow. Community pharmacy trials on automatic refill programs raised the proportion of adherent patients from a baseline range of 73.6% to 76.4% up to as high as 83.6%, according to research published in the American Journal of Managed Care. That is a realistic range to benchmark against, not a guarantee.

Report these numbers back to plans whenever you renew a network agreement. A pharmacy with two years of documented PDC gains has a very different conversation with a plan than one that shows up with anecdotes.

Set a Quarterly Tracking Cadence

Set a simple internal cadence for this. Pull PDC and refill data at the end of each quarter, compare it against the same quarter a year earlier, and note which interventions ran during the gap. A pharmacy that started medication synchronization in March, for example, should be able to point to a refill rate change by the third quarter. Without that kind of before-and-after tracking, an adherence program is just a service you offer, not a result you can prove.

• PDC percentage by drug class, tracked quarterly
• 30-day refill rate for enrolled versus non-enrolled patients
• Patient retention and prescription volume over the same period
• Number of documented MTM interventions tied to adherence

A Medicare Part D adherence program only works when the clinical piece and the marketing piece move together. The clinical tools, medication synchronization, refill reminders, and MTM, close the gap. The marketing decides whether patients actually show up for them. Start with your highest-risk polypharmacy patients, track PDC by drug class from day one, and let the results carry the conversation with plans at renewal.