The problem with How We Measure Medication Adherence: Prioritizing Refills Over Patient Health
For years, healthcare systems have been laser-focused on medication adherence – how consistently patients take their prescribed drugs. But a growing chorus of voices, including seasoned pharmacists like sarah Billups, are arguing that how we measure adherence is fundamentally flawed, often prioritizing prescription refills over actual patient well-being. This isn’t just a technical issue; it’s a critical one impacting patient care and resource allocation.
The Illusion of Adherence: Why Refills Don’t Tell the whole Story
Currently,the Centers for Medicare and Medicaid Services (CMS) heavily weights refill-based adherence measures – essentially,whether a patient consistently gets their prescriptions filled on time. This triple-weighting has driven a surge in strategies like automatic refills, extended-day supplies, and even phone calls from pharmacists reminding patients to pick up their medication.
While these tactics look good on paper, boosting performance metrics, they often miss the mark. As Billups points out, “It has nothing to do with what [patients] are really doing.” A full prescription bottle doesn’t guarantee a patient is actually taking the medication.
A More Reliable Indicator: Looking at LDL Levels
so, what does accurately reflect whether a patient is adhering to their medication regimen? Billups advocates for a simple, yet often overlooked, metric: LDL cholesterol levels for patients on statins. “If you want to know if a patient’s taking their statin, the best way to do that is to look at what their LDL is,” she explains. Lower LDL levels directly correlate with statin use and effectiveness,providing a far more meaningful measure of adherence than simply counting pills. Unfortunately,LDL isn’t routinely checked for all cholesterol patients,limiting its widespread use.
The downside of Chasing Metrics: Wasted Resources and Needless Intervention
the current system isn’t just inaccurate; it’s actively detrimental. Pharmacies are pressured to aggressively pursue adherence metrics, especially at year-end, leading to situations where patients are contacted for refills that aren’t medically urgent.
“You’ve got people in December…you have to call her and get her to fill her medication by Tuesday, or she flunks the measure,” Billups illustrates. “That’s not a medical emergency. It just isn’t.”
Furthermore, the focus on refills can lead to unnecessary intervention with patients who are already effectively managing their conditions. “There’s a substantial number of people…who are failing the adherence measure [because they] have excellent disease state control, and we shouldn’t be bothering them.”
The bigger Picture: Clinical Outcomes Matter Moast
The core issue is that the current adherence metric doesn’t address clinical outcomes. The entire system is geared towards getting prescriptions filled and picked up,often at the expense of truly impactful patient care. Imagine the possibilities if those resources were redirected towards more valuable services.
A Shift on the Horizon: CMS Changes in 2026
Fortunately, change is coming. In 2026, CMS will remove the triple-weighting from refill adherence metrics. This presents a crucial chance for pharmacies to re-evaluate their approach and prioritize patient-centered care.
Empowering Pharmacists: A Return to Personalized Care
Billups envisions a future where pharmacists are empowered to engage in meaningful conversations with patients. “If it looks like there’s an adherence concern, [pharmacists] can ask questions.”
Pharmacists, with their access to refill data and their direct patient interactions, are uniquely positioned to identify barriers to care – financial constraints, side effects, confusion about dosage – and help patients overcome them.This personalized approach is far more effective than simply pushing automatic refills.
Moving Forward: A Focus on Understanding, Not Just Compliance
The key takeaway is this: true medication adherence isn’t about filling prescriptions; it’s about understanding why a patient might be struggling and providing the support they need to manage their health effectively. By shifting our focus from metrics to meaningful engagement, we can finally prioritize patient health and unlock the full potential of pharmaceutical care.
References:
- billups,SJ. “Applying a clinical lens to medicaton adherence quality measures – do they measure up?” Presented at: American Society of Health-System Pharmacists Midyear 2025 Clinical Meeting and Exposition; December 7-10, 2025; Las Vegas, Nevada.
- Rodriguez F, Mar
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