The client is a major US health insurance payer operating in more than 30 states, with Medicare Advantage Prescription Drug (MAPD) and standalone Prescription Drug Plan (PDP) populations. Its Star Ratings depend heavily on medication adherence measures, which CMS triple-weights for diabetes, hypertension and cholesterol medications. Before working with Drips, the payer relied mainly on large pharmacies to engage members about adherence, an approach the case study describes as fragmented and ineffective.

Medication adherence is a key factor in Medicare Advantage Star Ratings. CMS assigns triple weight to adherence measures for diabetes, hypertension and cholesterol medications, using the Proportion of Days Covered (PDC) method: a member must have medication on hand at least 80% of the time to count as adherent. CMS also sets annual cut points for the share of members who must meet that threshold, and falling below them affects a plan's Star Rating and financial performance.

Non-adherence is costly as well. Conservatively, each non-adherent member adds an estimated $1,250 in avoidable costs for the plan and a further $949 in direct member costs each year. The payer wanted to raise adherence among members who had previously been non-adherent on Part D medications, including oral diabetes medications, hypertension medications and cholesterol statins.

Its existing approach relied primarily on large pharmacies for member engagement. That outreach was fragmented and ineffective, leaving adherence and Star Ratings below where they needed to be. The payer needed a more cohesive, member-centric way to reach these members and support them through to a refill.

Drips delivered a comprehensive outreach program built on its Conversations as a Service (CaaS) approach. Outreach begins with two-way conversational SMS reminders. Members are first asked to confirm their identity through a friendly introduction, then receive personalized reminders about upcoming refills based on their medication schedule.

When a member asks for help, or fails to pick up a medication after a set number of days, Drips drives a warm transfer to the payer's internal call team or the member's preferred pharmacy. The conversations use friendly, human-like persistence that is supportive rather than intrusive, and the program adapts to member behavior by varying the times and modalities used to reach people. Tailored scripting for different member groups, such as upcoming refills versus missed or past-due fills, further lifted engagement.

Drips' Client Success team ran the program alongside the payer, holding bi-weekly meetings to review performance, optimize strategies and identify market trends. The team monitored conversations and deliverability end to end, tested and adjusted continuously, and performed a mid-program health equity analysis of engagement, pharmacist transfers and adherence by race, gender, language, state and age group to find areas to optimize.

• 8.8% uplift in medication adherence compared with the previous year
• $3.41M net income and savings impact in the first year
• 1.198 million unique non-adherent members reached over nine months in 2024, with 43.1% engaging
• 58.8% of consistently non-adherent members refilled their medications
• Engaged members were 2.3 times more likely to refill on time and 4.1 times more likely to refill the same day
• Members who asked to speak with a pharmacist were 11.7% more likely to refill the same day