Perceived Barriers and Supports to Medication Adherence in Type 2 Diabetes: A Qualitative Study of Patients with and without a Zero-Dollar Copay Health Plan Benefit

Debra Winberg,1,2 Sarita V Panchang,3 Elizabeth Nauman,3 Brice L Mohundro,4 Tiange Tang,2 Eboni G Price-Haywood,5 Stephen Onufrak,6 Lizheng Shi,1 Alessandra N Bazzano7 1Department of Health Management and Policy, Georgetown University, Washington, DC, USA; 2Celia Scott Weatherhead School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA; 3Louisiana Public Health Institute, New Orleans, LA, USA; 4Louisiana Blue, Baton Rouge, LA, USA; 5Ochsner Clinic Foundation, New Orleans, LA, USA; 6Centers for Disease Control and Prevention, Atlanta, GA, USA; 7Department of Maternal and Child Health, University of North Carolina Chapel Hill School of Global Public Health, Chapel Hill, NC, USACorrespondence: Debra Winberg, Department of Health Policy and Management, Georgetown University, 3700 Reservoir Road, Washington, DC, 20057-1107, USA, Email Dw1051@georgetown.eduIntroduction: Medication adherence among individuals with type 2 diabetes (T2D) remains a critical determinant of disease management and health outcomes. While cost-sharing reductions such as a $0 copay (ZDC) for drugs are used to improve adherence, less is known about how patients with and without such benefits perceive barriers to adherence and what strategies may further support consistent medication use. This study explored barriers and facilitators to medication adherence among health plan members with T2D, including perceived barriers and potential strategies to enhance medication adherence.Methods: This qualitative study was conducted as part of a larger mixed-methods investigation examining medication adherence among individuals with T2D. The research team conducted semi-structured interviews with health plan members diagnosed with T2D. An interview guide was co-developed by a multidisciplinary team that included health services researchers, patients, health plan leaders, and clinicians, ensuring relevance and clarity across stakeholder groups. Interviews were conducted between June and December 2024, audio-recorded with participant consent, and transcribed verbatim. A descriptive qualitative analysis was conducted using both inductive and deductive approaches. Three members of the research team independently applied open coding techniques to the transcripts, iteratively refining themes through discussion and consensus. NVivo software was used to facilitate data organization and analysis.Results: In total, we interviewed 21 Louisiana Blue, a reginal health insurance plan, beneficiaries (11 with the ZDC benefit and 10 without the ZDC benefit). We identified four themes from the interviews – themes were the same across the two groups - 1) Costly medication copays were described as a key barrier to taking medications as prescribed; 2) memory aids, family support, and routines were identified as strategies to maintain adherence; 3) health care providers were crucial in educating members about their medication, including responding to concerns such as side effects; and 4) members’ perceptions of pharmaceutical companies were coupled with concerns about medication costs. Barriers and facilitators were largely similar among participants with and without the zero-dollar copay benefit.Conclusion: Findings suggest that eliminating copayments alone does not resolve the multifaceted barriers to adherence, and that limited awareness of benefit status may further constrain the impact of such programs; introduction.Plain Language Summary: Managing type 2 diabetes often requires people to take medications regularly, but many patients have difficulty doing so. One common barrier is the cost of medications. Some health plans try to improve adherence by removing out-of-pocket costs, such as offering a $0 copay benefit. However, it is not well understood how patients experience barriers to taking their medications or what strategies might help them stay on track.This study explored these issues by interviewing members of Louisiana Blue who have type 2 diabetes. Between June and December 2024, researchers conducted interviews with 21 health plan members, including 11 who had a $0 copay benefit and 10 who did not. The interview questions were developed with input from researchers, clinicians, patients, and health plan leaders. The research team analyzed the interview transcripts to identify common themes.Four main themes emerged, and they were similar for people with and without the $0 copay benefit. However, many participants were not fully aware of which medications were covered by the $0 copay benefit, which may have influenced how they experienced medication costs.First, many participants said that high medication costs made it difficult to take their medications as prescribed. Second, people described strategies that helped them remember their medications, such as using reminders, building routines, and relying on family support. Third, health care providers played an important role in explaining medications and addressing concerns, including possible side effects. Finally, some participants expressed concerns about pharmaceutical companies and drug pricing.Overall, while reducing medication costs may help improve adherence, other factors also matter. Supporting patients with reminders, strong communication with providers, and broader social support may help people with diabetes take their medications more consistently.