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CRACKING THE CODE: MEDICAID PHARMACISTS IMPROVING MEDICATION ADHERENCE -aPHP

Writer's picture: aPHPaPHP

Updated: 1 day ago


 

Two pharmacists in white coats standing in a bright, well-organized pharmacy, smiling confidently, representing teamwork and the role of population health pharmacy in improving health outcomes and medication adherence.
Photo by YuriArcursPeopleimages on Envato
 

This blog post explores how Medicaid pharmacists implement innovative strategies and leverage actionable insights to improve medication adherence, drive cost savings, and enhance population health outcomes.


 

Medicaid Pharmacists: Advancing Population Health Through Policy & Practice (Introduction)


Medicaid pharmacists drive population health pharmacy strategies that enhance medication adherence and improve health outcomes for vulnerable populations.


Their ability to navigate complex coverage criteria, optimize medication access, and apply policy-driven interventions ensures that patients receive the care they need.



At aPHP, we define population health pharmacy as a pharmacist-led population health approach that integrates clinical expertise, data-driven strategies, and public health principles to optimize healthcare frameworks.



This approach focuses on:

  • Improving medication adherence

  • Increasing medication access

  • Driving health equity by bridging care gaps beyond traditionally recognized pharmacist roles


Examples of Traditional Pharmacist Roles

Compounding

Dispensing Medications

Hospital Rounds

Medication Reconciliation

Immunizations

Medication Safety

OTC Subject Matter Expertise

Patient Counseling

Pharmacy Operations


Globally, pharmacists have long been positioned as central care providers. However, in the U.S., their role in direct patient care has been historically restricted within physician-led models. Reaffirming and expanding pharmacists’ contributions aligns with evidence-based practices and strengthens their impact on population health initiatives.


As pharmacist-driven programs gain traction, Medicaid pharmacists play a pivotal role in closing health gaps and ensuring that policy-driven interventions translate into productive patient outcomes.


This blog post explores how Medicaid pharmacists implement innovative strategies and leverage actionable insights to improve medication adherence, drive cost savings, and enhance population health outcomes.

 

A diverse group of confident healthcare professionals, including pharmacists and medical practitioners, standing together on a staircase in a medical setting, symbolizing collaboration and the central role of pharmacists in improving medication adherence and advancing population health.
Photo by ASphotostudio on Envato
 

While pharmacists serve as central care providers worldwide, physician-led models in the U.S. have gradually limited their direct patient care role. Reaffirming their expertise supports evidence-based practices and expands their impact in population health.


 

Breaking Barriers: Challenges in Medicaid Adherence



Medicaid populations face significant barriers to improving medication adherence, requiring patient-centered and innovative solutions. Key challenges, visually represented below, include:


Visual representation of barriers faced by Medicaid populations: complex medication regimens, health literacy gaps, limited transportation, and socioeconomic challenges such as housing instability and food insecurity.

Medicaid pharmacists are at the forefront of tackling these issues, helping managed care organizations (MCOs) bridge care gaps and reduce disparities that negatively impact adherence rates.¹



Dr. La Kesha Y. Farmer, our founder, has direct expertise in this space, having successfully led multiple Medicaid Clinical Pharmacy Adherence Programs as a Population Health Pharmacist (PHP) within an MCO.



Her leadership advanced medication adherence and generated measurable cost-savings, reinforcing the value of pharmacists in optimizing Medicaid outcomes. 



Additionally, studies like Montgomery et al. further validate the impact of Medicaid pharmacists in driving adherence improvements within MCOs.⁴


 


 

Medicaid Pharmacists: Improving Medication Adherence Through HEDIS, Advocacy, and Beyond


Medicaid pharmacists go beyond traditional medication therapy management (MTM), leveraging policy-driven interventions and Medicaid-specific adherence strategies to drive measurable improvements in medication adherence. Their work focuses on:


  • HEDIS Measures: Leveraging Data for Optimal Outcomes

  • Enhancing Patient Access and Experience

  • Empowering Patients Through Tailored Education

  • Leveraging Technology to Improve Adherence

  • Optimizing MTM for Medicaid Populations

  • Addressing Social Determinants of Health (SDOH)



Each section below will explore how Medicaid pharmacists drive measurable impact in these areas to improve medication adherence and patient outcomes.


 

HEDIS Measures: Leveraging Data for Optimal Outcomes



As part of population health pharmacy initiatives, Medicaid pharmacists play a critical role in improving medication adherence by leveraging claims data and metrics to identify and assist non-adherent members and drive measurable outcomes.


An example of metrics include the Healthcare Effectiveness Data and Information Set (HEDIS), a set of quality measures established by the National Committee of Quality Assurance (NCQA)


Real-world programs like the Targeted Intervention Program™ (TIPs) showcase how HEDIS-driven pharmacist interventions enhance clinical performance.⁷ 


These programs support Medicaid beneficiaries in meeting national health objectives while also providing valuable prescribing insights, such as drug utilization reviews (DURs), to optimize medication use and improve patient safety.


 


A blue weekly pill organizer with several prescription medications in the background, highlighting the role of population health pharmacy in improving medication adherence and promoting effective medication management for quality outcomes.
Photo by Lukas on Pexels

 

Enhancing Patient Access and Experience


Medicaid pharmacists enhance patient experience by ensuring beneficiaries receive optimized, cost-effective care¹. This includes identifying barriers, triaging patient-provider concerns, and facilitating connections to preferred providers.


These efforts align with the Agency for Healthcare Research and Quality’s (AHRQ) Consumer Assessment of Healthcare Providers and Systems (CAHPS) program, which prioritizes patient-centered care and experience-driven provider selection—both key factors in Medicaid quality initiatives.


 


Empowering Patients Through Tailored Education



Medicaid pharmacists deliver personalized education that reinforces how medication adherence directly impacts the management of chronic conditions like diabetes, hypertension, and asthma, helping patients achieve improved health outcomes.


By building trust and using culturally competent communication, they empower patients to take control of their health defined by the World Health Organization (WHO) as a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity.


Pharmacist providing patient education during a consultation, demonstrating the use of a pulse oximeter to empower patients in managing their health, which includes improving medication adherence
Photo by DC_Studio on Envato
 


Leveraging Technology to Improve Adherence



Medicaid pharmacists integrate digital health tools into patient care, harnessing technology as a vital strategy for improving medication adherence.


These innovations enhance patient engagement, streamline provider communication, and address adherence barriers. 



Key examples include: 


  • Adherence Reminder Apps: Help patients stay on track with medication schedules.

  • Telehealth Services: Facilitate real-time, remote consultations to identify and resolve adherence challenges efficiently.

  • Mobile health (mHealth) tools: Devices such as smartphones, blood pressure monitors, and wireless scales provide timely reminders and enhance patient-provider communication.


By leveraging these digital solutions, Medicaid pharmacists drive sustained medication adherence, leading to improved health outcomes in Medicaid populations.



 


Optimizing MTM for Medicaid Populations


Medicaid pharmacists leverage managed care frameworks and formulary management to enhance adherence and resolve prior authorization issues, reducing costs. They streamline adherence through packaging and refill coordination.


Beyond adherence, MTM serves as a bridge to care by addressing patient-specific barriers and integrating pharmacy services into broader healthcare initiatives.


 

Addressing Social Determinants of Health (SDOH)


Medicaid pharmacists, as integral members of the healthcare team, work collaboratively with a diverse group of stakeholders to effectively address SDOH-related challenges that impact medication adherence, ensuring more equitable healthcare access and improved health outcomes.


6 Key SDOH initiatives driven by Medicaid pharmacists include:




 

A pair of feet standing near a ‘Mind the Gap’ sign on a train platform, symbolizing the role of Medicaid pharmacists in addressing social determinants of health (SDOH) and improving medication adherence by bridging gaps in healthcare access.
Photo by Gnepphoto on Envato
 

  • Medication Access.

    Activating prescription delivery services removes access barriers, ensuring patients receive medications without mobility or transportation challenges.¹



  • Closed-Loop Referrals.

    Utilizing platforms like 211 or FindHelp.org to facilitate closed-loop referrals—ensuring patients are successfully connected to essential social services and that healthcare providers receive confirmation of completed referrals, removing barriers that interfere with medication adherence.





  • Workforce Training.

    Research supports SDOH-focused training for pharmacy interns and technicians to assess social needs and adherence barriers.² Medicaid pharmacists, including Dr. Farmer, have implemented similar strategies in managed care, reinforcing the impact of pharmacist-led SDOH initiatives in population health pharmacy.


 


Shaping Policy: Medicaid Pharmacists Leading Systemic Change


Medicaid pharmacists function as Medicaid Champions, leading policy initiatives by analyzing adherence trends and presenting actionable recommendations to Medicaid policymakers and program leaders.


Their advocacy addresses systemic barriers—such as formulary restrictions, copay challenges, and access limitations—ensuring access to care remains a priority while improving medication adherence.⁶




By shaping policies that eliminate disparities, their leadership advances equitable care and drives systemic change.




Dr. Farmer exemplified this impact by presenting her clinical pharmacy best practices on improving medication adherence to the Global Medi-Cal DUR Board of the California Department of Health Care Services (DHCS).


She shared how she integrated culturally competent care models into her program development to advance health equity, driving improved health outcomes.


Her expertise in cultural competency is further detailed in 9 Proven Strategies for Reducing Health Disparities in Pharmacy Practice, which highlights actionable approaches to addressing health inequities and fostering systemic change.


 

An advocate holding a bullhorn during a protest, symbolizing the role of population health pharmacy in improving medication adherence, advocating for equitable healthcare, addressing health disparities, and empowering underserved communities.
Photo by Prostock-studio on Envato
 

Redefining Leadership: Medicaid Pharmacists as Population Health Pharmacy Experts




The impact of Medicaid pharmacists on population health pharmacy is evident in their leadership of initiatives that improve medication adherence. The following strategies illustrate how their efforts enhance patient outcomes and strengthen healthcare systems.




  1. Reducing Healthcare Costs by Improving Medication Adherence


Medicaid Pharmacists help decrease hospitalizations and emergency room visits, generating substantial cost savings for Medicaid programs.¹ ³



Given that the U.S. has the highest per capita GDP for healthcare, Medicaid pharmacists—like their non-Medicaid counterparts—help bridge cost gaps by optimizing medication use and reducing preventable health expenditures.


This finding aligns with the Triple Aim framework—enhancing patient experience, improving population health, and lowering healthcare costs—reinforcing Medicaid pharmacists’ role in delivering sustainable, high-quality care.


 


 

  1. Advancing Cultural Competency in Pharmacy Practice


Cultural competency is a cornerstone of population health pharmacy, ensuring that medication adherence strategies account for diverse patient needs, beliefs, and social determinants of health.


Medicaid pharmacists integrate culturally tailored interventions into patient care, recognizing how language barriers, historical mistrust, and systemic inequities influence adherence.


Race concordance—patients being treated by healthcare providers of the same racial/ethnic background—has been shown to increase trust and engagement, reinforcing the need for diverse representation within pharmacy leadership.



By embedding cultural competency into Medicaid pharmacy programs, Medicaid pharmacists strengthen patient relationships, improve adherence, and advance health equity.


 

A friendly pharmacist in a white coat explaining a prescription to a patient, demonstrating how population health pharmacy fosters trust and improves medication adherence through patient-centered care.
Photo by YuriArcursPeopleimages on Envato 
 

  1. Collaborating with Interdisciplinary Teams to Improve Medication Adherence


Medication adherence extends beyond pharmacy—it requires a multidisciplinary, team-based approach for sustainable patient outcomes.


Medicaid pharmacists collaborate across disciplines to align patient-centered medication plans with broader healthcare goals.


Partnering with physicians, nurses, case managers, and social workers, they advocate for medication access and treatment optimization, reducing disparities and enhancing outcomes.


Their leadership in clinical interventions ensures adherence remains a priority across healthcare touchpoints.



 

Case Study: Medicaid Pharmacists Reducing Costs & Improving Adherence




Medicaid pharmacists transform population health pharmacy principles into reproducible outcomes, reducing costs and improving medication adherence.


The following case study highlights pharmacist-led interventions that successfully improved adherence and strengthened Medicaid program efficiency.


A Medicaid initiative targeting high-risk, non-adherent patients with chronic conditions integrated MTM sessions and community-based partnerships (CBOs), resulting in:




These results underscore the critical role of Medicaid pharmacists in improving medication adherence and advancing sustainable population health pharmacy outcomes.


 


Confident pharmacist in a white coat standing in a well-stocked pharmacy aisle, giving a thumbs-up gesture, symbolizing trust, reliability, and the role of population health pharmacy in improving medication adherence and addressing health outcomes across communities.
Photo by YuriArcursPeopleimages on Envato
 

Medicaid Pharmacists: Leading the Next Era of Medication Adherence




Medicaid pharmacists are more than medication experts—they are Medicaid Champions, leading population health pharmacy efforts.


This article has demonstrated how Medicaid pharmacists advance the profession by closing care gaps and optimizing healthcare frameworks.


Their work aligns with evidence-based practices and underscores the necessity of expanding Medicaid pharmacist-led initiatives to integrate their expertise into policy and practice, particularly within state-based population health models (looking at you, DHCS).


As the healthcare landscape evolves, Medicaid pharmacists must remain central to efforts that advance collective population health pharmacy initiatives.


Sustaining their impact will require continued investment, system-wide support, and collaboration, ensuring that pharmacist-driven solutions remain at the forefront of equitable and sustainable healthcare.


 

Topics: Medication Adherence



 

References

  1. Centers for Disease Control and Prevention. “Medication Therapy Management in Medicaid.” Centers for Disease Control and Prevention website. Updated March 2021. Accessed December 26, 2024. https://www.cdc.gov/cardiovascular-resources/media/MTM_in_Medicaid-508.pdf.

  2. Daly, Christopher J., and David M. Jacobs. “Implementing a Social Determinants of Health Program.” University at Buffalo School of Pharmacy and Pharmaceutical Sciences, n.d., Community Pharmacy Foundation. Accessed 31 Jan. 2025.

  3. Moczygemba, Leticia R, et al. “Comprehensive Health Management Pharmacist-Delivered Model: Impact on Healthcare Utilization and Costs.” Am J Manag Care, vol. 25, no. 11, 14 Nov. 2019, www.ajmc.com/view/comprehensive-health-management-pharmacistdelivered-model-impact-on-healthcare-utilization-and-costs?utm_source=chatgpt.com. Accessed 31 Jan. 2025.

  4. Montgomery, E., Sherod-Harris, T., Adkins, M., & Hinely, M. “Impact of Pharmacy Involvement on Care Gap Closure in Managed Medicaid Patients.” Am J of Health-System Pharmacy, Published 21 Nov. 2024, doi:10.1093/ajhp/zxae328. Accessed January 30, 2024. https://pubmed.ncbi.nlm.nih.gov/39570898/.

  5. The American Journal of Managed Care. “Cost Savings From an mHealth Tool for Improving Medication Adherence. Am J Manag Care. Published September 1, 2023. Accessed December 26, 2024. https://www.ajmc.com/view/cost-savings-from-an-mhealth-tool-for-improving-medication-adherence.

  6. The American Journal of Managed Care. “Reducing Barriers to Medication Access and Adherence for ACA and Medicaid Participants: A Peer-to-Peer Community-Based Approach. Am J Manag Care. Published April 22, 2022. Accessed December 26, 2024. https://www.ajmc.com/view/reducing-barriers-to-medication-access-and-adherence-for-aca-and-medicaid-participants-a-peer-to-peer-community-based-approach.

  7. Weiser P. “How Pharmacists Can Influence HEDIS Measures and Value-Based Care.” Outcomes™ Blog. September 21, 2022. Accessed December 29, 2024. https://blog.getoutcomes.com/perspectives/how-pharmacists-can-influence-hedis-measures-and-value-based-care.

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