Statin therapy plays a foundational role in the prevention and management of cardiovascular disease, diabetes, and hypertension, three of the most prevalent chronic conditions in the United States. According to Yale Medicine, 47 million Americans take statins daily, yet thousands of eligible patients remain untreated or nonadherent. For patients with diabetes or cardiovascular disease, these gaps in care can mean the difference between a preventable hospital visit and a major cardiac event.
To meaningfully close these gaps, we must address the root causes, ranging from limited patient education and health literacy to system-level barriers such as care team silos and underutilization of pharmacists. Only by tackling these challenges head-on can we unlock the full value of statin therapy and guarantee that patients receive the right care at the right time.
Statins are widely accepted as first-line therapy for reducing cardiovascular risk, particularly in patients with diabetes or established heart disease. Even with their use being a first line of defense, medication adherence remains a persistent challenge.
For health plans and pharmacists operating in value-based care environments, the stakes are high when it comes to serving patients with chronic conditions. Gaps in statin use not only jeopardize patient outcomes but also carry significant financial implications, as well as negatively impact HEDIS scores, Star Ratings, and overall care quality.
One such metric, Statin Use in Persons with Diabetes (SUPD), is a key CMS Part D Star Rating measure that contributes to performance-based incentives for Medicare Advantage plans. Every missed opportunity for statin adherence translates into missed potential for clinical improvement and operational success.
When patients fall through the cracks, health plans see lower performance on key metrics like SUPD and Medication Adherence for Cholesterol (Part D), impacting their CMS Star Ratings and overall contract success.
Poor adherence doesn’t just affect metrics; it affects lives. Cleveland Clinic notes that patients who don’t take their statins are at risk for several side effects, including heart attack, stroke, and heart failure. These preventable events lead to higher costs and lower patient satisfaction, two outcomes that value-based care is designed to avoid.
To deliver better care and better value, pharmacists and health plans must employ targeted, data-driven strategies. But first, they must understand the barriers preventing progress.
Despite their proven benefits, statins are often misunderstood. Patients may worry about side effects, question their necessity, or mistakenly believe that lifestyle changes alone can substitute for medication. These concerns are amplified by low health literacy, misinformation from non-clinical sources, and cultural perceptions of chronic medication use.
Cultural beliefs and mistrust can further complicate the picture. For example, in some communities, taking daily medication is seen as a sign of weakness or dependence, while others may rely on home remedies or family advice over clinical recommendations. These deeply personal views must be addressed with empathy and medical expertise.
Pharmacists are perfectly positioned to bridge this gap. Whether through one-on-one counseling, medication therapy management (MTM) consults, or proactive outreach, pharmacists can clarify misconceptions, explain benefits, and make sure that patients feel informed and empowered.
To maximize this opportunity, health plans and pharmacy partners should invest in multilingual, pharmacist-delivered education, whether in person, over the phone, or with digital content. Culturally competent communication sees that patients not only hear the message, but also trust it.
Another significant barrier to statin medication is the underutilization of pharmacists themselves. In many communities, especially rural or underserved ones, patients lack access to pharmacists who can assess their eligibility and provide intervention. This challenge is exacerbated by pharmacy closures and staff shortages, which further reduce access to care.
Even when data indicates that a patient qualifies for statin therapy, it doesn’t always translate to action. The disconnect between insights and pharmacist-enabled outreach limits the potential to close therapy gaps at scale.
Health plans can combat this by empowering pharmacists with timely, targeted opportunities, such as TMRs (targeted medication reviews) and CMRs (comprehensive medication reviews) that focus specifically on statin initiation. But access to patients is only part of the equation. Pharmacists must also have the tools and context to deliver meaningful consults.
That’s where remote pharmacy SaaS solutions like Alliance by Aspen RxHealth come in. Alliance equips in-house care teams with a robust medication management platform featuring guided workflows, real-time data, clinical alerts, and patient insights, allowing them to intervene efficiently and effectively, even in the absence of brick-and-mortar pharmacies.
Aspen RxHealth’s nationwide community of pharmacists delivers clinical services on behalf of health plans through the BeWell platform. With tools to schedule follow-up outreach, send multilingual patient letters, and log adherence counseling, pharmacists can support consistent, measurable engagement, making outreach more precise and timely.
Too often, primary care providers, specialists, and pharmacists operate independently, each focused on their respective corners of the patient’s journey. This lack of coordination leads to fragmented care and missed opportunities to reinforce statin therapy.
Statin initiation may not be addressed during a routine doctor's visit, especially if the patient appears stable or has competing health concerns. Without a prompt or follow-up from a pharmacist or care manager, the therapy may remain indefinitely deferred.
Integrated workflows and shared platforms are the antidote to this fragmentation. When all members of the care team, physicians, pharmacists, and case managers, have visibility into consult notes and medication recommendations, the opportunity to align around statin adherence becomes much greater.
With Aspen RxHealth’s solutions like Alliance and our nationwide network of pharmacists to deliver clinical services, documentation and reporting capabilities make sure pharmacist interventions don’t exist in a vacuum. Consult summaries can be reviewed by pharmacists, in-house teams, and health plans, creating transparency and accountability. This visibility drives collaboration and promotes unified efforts toward the same medication adherence goals.
Adherence isn’t a one-time event, but rather a sustained behavior. Yet, many health plans lack the technology infrastructure to maintain engagement over time. Gaps in automated outreach, refill reminders, and follow-up systems can cause patients to fall off track and become unhappy with their care. Alert fatigue and disjointed systems also reduce the likelihood of timely interventions.
Without closed-loop communication, opportunities for adherence counseling, follow-up education, or refill interventions, the ability to track progress in a meaningful way is lost.
Pharmacists and health plans can change that narrative. By investing in shared platforms that capture outreach, document follow-ups, and send patient-friendly reminders, care teams can be sure that statin adherence isn’t just recommended, rather reinforced.
Through the BeWell platform, Aspen RxHealth’s nationwide pharmacist community powers our clinical services for health plans across the country. By matching patients with pharmacists based on language and clinical specialties, performing personalized outreach, completing consults, and recording adherence plans, pharmacists create a consistent and measurable approach to engagement. This closed-loop system not only supports patient success but also serves as a differentiator for health plans looking to achieve top-tier quality performance.
Success in statin adherence is measurable. It looks like more eligible patients starting therapy, better persistence on medications over time, and it results in improved HEDIS metrics, Star Ratings, and patient outcomes.
To maintain this success, health plans must invest in data-sharing infrastructure, provide pharmacists with access to performance insights, and create a culture of continuous feedback. When pharmacists can see the downstream impact of their interventions: fewer hospitalizations, improved metrics, they are more engaged and aligned with plan goals.
Statins adherence represents both a clinical challenge and a strategic opportunity. As a CMS-aligned performance measure, it represents a high-impact opportunity for health plans and pharmacists to deliver better care, reduce cardiovascular risk, and strengthen value-based outcomes.
By tackling the four core barriers, education, access, silos, and technology, health plans can close therapy gaps with confidence. But it requires partnership. Pharmacists must be empowered. Data must be shared. And patients must be engaged.
Are you ready to improve statin adherence and elevate your Star Ratings? Let’s build a care model that drives measurable results. Contact Aspen RxHealth today to learn more about how we can help patients close their statin therapy gaps, one consult at a time.