Type 2 diabetes mellitus (T2DM) is a chronic disease with an increasing prevalence worldwide. According to the WHO, approximately 422 million people were living with diabetes in 2023. In Indonesia, the number of diabetes cases continues to increase, making medication adherence essential to achieve successful therapeutic outcomes. One strategy to improve medication adherence is the use of a pill box as a medication reminder. To determine the effect of pill box use on medication adherence and therapeutic outcomes among patients with type 2 diabetes mellitus enrolled in the Chronic Disease Management Program (PROLANIS) at Sangkrah Primary Health Center, Surakarta. This study employed a quasi-experimental pretest–posttest control group design involving 60 respondents, consisting of 30 participants in the control group and 30 in the intervention group. Medication adherence was assessed using the 8-item MMAS-8 and the Pill Count method, while therapeutic outcomes were evaluated based on HbA1c levels. Data were analyzed using univariate analysis, the Chi-square test, and the Wilcoxon Signed-Rank Test with a significance level of p < 0.05. The Wilcoxon Signed-Rank Test showed that pill box use significantly improved medication adherence based on both the MMAS-8 and Pill Count methods (p < 0.001). The proportion of adherent patients measured by Pill Count was higher in the intervention group (93.3%) than in the control group (70.0%). Bivariate analysis indicated that HbA1c, family support, and healthcare provider support were significantly associated with medication adherence (p < 0.05), whereas age, sex, education, occupation, duration of diabetes, comorbidities, and prescribing patterns were not significantly associated (p > 0.05). Therefore, a pill box can be recommended as a simple and effective medication reminder to help patients take their medications regularly and support successful therapeutic outcomes. The use of a pill box significantly improved medication adherence among patients with type 2 diabetes mellitus.