Building upon our 2014 report titled Prescription Drug Adherence in Medicaid Managed Care, this report provides updated analyses performed on medication adherence, assesses the impacts of Medicaid expansion and the COVID-19 pandemic on medication adherence, and offers recommendations to further improve medication access and adherence in Medicaid. Key takeaways include:

• States that adopted Medicaid expansion created substantial medication access.
• A concerning decrease in prescriptions per Medicaid enrollee – especially with maintenance medications – occurred during the COVID-19 pandemic.
• State policies can facilitate or inhibit medication access and adherence.
• Medicaid MCOs have implemented various adherence initiatives to identify adverse medication utilization, provide a comprehensive and integrated support system to close care gaps, and communicate with members to promote adherence.
• The Medicaid MCO industry’s performance improved on 14 of 15 HEDIS measures related to medication adherence.