We're surveying health plans nationwide to understand their biggest challenges in driving medication adherence for better outcomes. Share your insights to see how you stack up to industry peers and inform our 2026 industry report.
Based on industry research and health plan responses
Health plans don’t have a data problem. They have a timing problem.
When health plans rely on claims data alone, they’re playing catch-up and reacting to what already happened. Additionally, they don’t have visibility into what occurred before a member entered the health plan or outside of traditional coverage channels.
And when signals that indicate delays in therapy or adherence issues are delayed or fragmented, care teams don’t have the information they need to intervene and take action. That means missed opportunities to identify highrisk members earlier, prioritize outreach more effectively and help ensure members start and stay on therapy.
While this gap is especially visible during January’s surge of new members, reverification and coverage activity, it’s a year-round issue. Therapy delays, discontinuation and unnotified changes often remain hidden until well after the window to intervene has passed.
That challenge is becoming harder to ignore. As the Centers for Medicare & Medicaid Services (CMS) pushes the industry toward electronic prior authorization, shorter decision timeframes and greater transparency, expectations are shifting. It’s no longer enough for health plans to make faster decisions—those decisions must translate into faster therapy starts and sustained adherence.
This report examines where breakdowns occur today— especially in the moments between prescribing, therapy start and ongoing adherence. And what that means for health plans that must act within increasingly narrowing intervention windows.
This report explores:
Health plans don’t have a data problem. They have a timing problem. When health plans rely on claims data alone, they’re playing catch-up and reacting to what already happened. Additionally, they don’t have visibility into what occurred before a member entered the health plan or outside of traditional coverage channels.
And when signals that indicate delays in therapy or adherence issues are delayed or fragmented, care teams don’t have the information they need to intervene and take action. That means missed opportunities to identify highrisk members earlier, prioritize outreach more effectively and help ensure members start and stay on therapy.
While this gap is especially visible during January’s surge of new members, reverification and coverage activity, it’s a year-round issue. Therapy delays, discontinuation and unnotified changes often remain hidden until well after the window to intervene has passed.
