TL;DR
Most clinics can’t see in time whether a patient filled a prescription or why they stopped taking it, so the default response is a refill reminder. A reminder doesn’t fix cost, side effects, or confusion.
Find out why each patient stopped, and match the response to the reason, e.g., financial help for cost and a clinician’s call for side effects.
See how medication adherence worksWriting the prescription is the step everyone counts as a success. After that, the patient still has to fill it, pay for it, understand it, put up with the side effects, and keep taking it, and the outcome depends on those later steps.
Missed medication has a cost. A CDC report links taking medication as prescribed to better control of chronic disease and lower mortality, and it links nonadherence to more hospital admissions and higher costs.
Patients in poor health skip medication over cost more often
In a national CDC survey, about 1 in 12 adults aged 18 to 64 who took prescription medication skipped doses, took less, or delayed a refill to save money. The rate was more than twice as high for adults in fair or poor health, adults with a disability, and adults without insurance.
Adults who didn’t take medication as prescribed because of cost
- Uninsured22.9%
- With a disability20%
- In fair or poor health18%
- All adults8.2%
- On Medicaid8%
- With private insurance6.5%
The patients who skip medication most often are the ones a clinic most needs to keep on treatment, and a refill reminder doesn’t help them pay for it.
Why a refill reminder is the wrong response
Most clinics keep a medication list in the EHR, but they can’t see in time whether the patient filled the prescription, stopped taking it, or ran into a problem. So the default response is a reminder. A missed refill shows that a patient stopped, and it doesn’t show why.
We separate two kinds of nonadherence, because each needs different help. In primary nonadherence, the patient never fills the first prescription, which may call for cost support, education, or a prior authorization that someone needs to resolve. In refill nonadherence, the patient starts the medication and then stops, which may call for a check on side effects, refills lined up for the same day, or a clinical follow-up.
Each barrier gets its own response
Financial assistance or a generic alternative.
A clinician.
Pharmacy coordination.
Medication reconciliation, where a pharmacist or nurse goes through the new list with the patient.
Start with the patients at highest risk
We suggest starting with heart failure, COPD, diabetes, hypertension, behavioral health, oncology, and patients whose medications changed at discharge. In those groups, better adherence can mean fewer readmissions, better control of chronic disease, and better quality and Star ratings. We measure the primary fill rate and the proportion of days covered, which is the share of days the patient had the medication on hand.
Ask your team how many patients on your highest-risk medications stopped filling them last quarter, and whether anyone knows why.
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