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.

Introduction: 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.