Source: https://ensurecare.ai/blog/the-prescription-was-the-easy-part > Patients skip medication because of cost, side effects, or confusion. A refill reminder fixes none of those, so each barrier needs its own response. Medication adherence # The prescription was the easy part Patients skip medication because of cost, side effects, or confusion. A refill reminder fixes none of those, so each barrier needs its own response. By [EnsureCare Team](https://ensurecare.ai/about). 2 min read ## TL;DR **The gap** 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. **What closing it looks like** 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 works](https://ensurecare.ai/modules/medication-adherence) Writing 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](https://www.cdc.gov/mmwr/volumes/66/wr/mm6645a2.htm) 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. A sketch of a man holding up his phone. ## Patients in poor health skip medication over cost more often In a [national CDC survey](https://www.cdc.gov/nchs/products/databriefs/db470.htm), 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 1. Uninsured**22.9%** 2. With a disability**20%** 3. In fair or poor health**18%** 4. All adults**8.2%** 5. On Medicaid**8%** 6. With private insurance**6.5%** Percent of adults aged 18 to 64 who took prescription medication in 2021. Source: CDC National Center for Health Statistics, Data Brief No. 470, 2023. 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 - Cost. Financial assistance or a generic alternative. - Side effects. A clinician. - Getting to a pharmacy. Pharmacy coordination. - Confusion after a medication change at discharge. Medication reconciliation, where a pharmacist or nurse goes through the new list with the patient. **Good to know** Without pharmacy claims data, any adherence number is an estimate. We say so when the claims data is missing, because clinicians stop trusting a program that overstates what it knows. ## How EnsureCare closes the gap Estimate the impact with your own numbers. [Check your numbers](https://ensurecare.ai/roi) 1. 01. **Predict** Flag prescriptions that were never filled and refills that are late. 2. 02. **Prevent** Find out why, and match the response to the barrier. 3. **Protect** Confirm the patient is taking the medication, and send clinical problems to a clinician. ## 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. Share this article FAQ ## Questions on this topic. ### Why is a refill reminder the wrong tool for nonadherence? A missed refill shows that a patient stopped, and it doesn’t show why. Cost, side effects, trouble getting to a pharmacy, and confusion after discharge each need a different response, and a reminder doesn’t address any of them. ### What is the difference between primary and refill nonadherence? In primary nonadherence, the patient never fills the first prescription. In refill nonadherence, the patient starts the medication and then stops. Primary nonadherence may need cost support, education, or a resolved prior authorization, while refill gaps may need a check on side effects or a clinical follow-up. ### How should medication adherence be measured? Use the primary fill rate, the proportion of days covered, gaps in therapy, and how long patients stay on therapy. When pharmacy claims data isn’t available, say so, because any adherence number without claims data is an estimate. ## More from the blog [See all articles](https://ensurecare.ai/blog) - [Agentic AI **Care Adherence: The unaddressed gap** Clinics already know where patients fall out of care. An agentic AI workforce does the follow-up work on each case, and staff make every judgment call. Read the article](https://ensurecare.ai/blog/care-adherence-the-unaddressed-gap) - [No-shows **Why patient no-shows are a coordination failure** We keep treating a coordination problem like a messaging problem. Patients miss visits because something gets in the way, and another reminder doesn’t fix it. Read the article](https://ensurecare.ai/blog/why-patient-no-shows-are-a-coordination-failure) - [Referrals **Half of referrals never close the loop. Then comes the friction.** About half of specialist referrals are never completed. Track each one until the specialist reports back, and fix prior authorization problems before the visit. Read the article](https://ensurecare.ai/blog/half-of-referrals-never-close-the-loop) ## Bring us one care gap. Let’s close it together. Pick an area where your team schedules care but patients struggle to receive it. Join us for a 30-minute walkthrough to see how EnsureCare can close that gap in your care setting. EnsureCare [Book a demo](https://ensurecare.ai/book-demo) [Run your ROI numbers](https://ensurecare.ai/roi) Buy through your cloud marketplace - [Available in AWS Marketplace](https://aws.amazon.com/marketplace/pp/prodview-y62fqi76k4iee)