For medical practices, improving medication adherence therefore requires looking beyond what patients do after dispensing. It means creating a prescribing process that anticipates potential barriers, supports informed decisions, and makes the transition from the exam room to the pharmacy as clear and manageable as possible.
Key takeaways
- Medication adherence begins before dispensing because patients can encounter financial, informational, logistical, and behavioral barriers before ever obtaining a medication.
- Approximately one-quarter of new prescriptions may never be filled, making primary medication nonadherence an important consideration for providers.
- Medication affordability remains a significant obstacle, with about one in four U.S. adults reporting difficulty affording prescription drugs.
- Clear patient education and shared decision-making can help practices identify concerns and establish realistic treatment expectations before prescribing.
- Standardized prescribing workflows can make it easier to address common adherence barriers consistently across the practice.
- Technology can help bridge the gap between prescribing and pickup by giving patients timely information about their prescriptions, pharmacies, and potential savings.
Medication adherence is often characterized solely as patient behavior: Did the patient pick up the medication? Are they taking the correct dose? Did they stop treatment early?
Those questions matter, but they begin too late in the process. Adherence can be influenced well before a patient reaches the pharmacy counter. Whether patients understand why they need a medication, believe the benefits are worth the potential risks, can afford it, and know where and how to obtain it can all affect what happens after a prescription is written.
For medical practices, improving medication adherence therefore requires looking beyond what patients do after dispensing. It means creating a prescribing process that anticipates potential barriers, supports informed decisions, and makes the transition from the exam room to the pharmacy as clear and manageable as possible.
Medication Adherence: Before the Prescription is Written
Medication adherence is frequently framed as something that happens after a prescription has been filled. Yet there is an important stage before a patient takes the first dose: primary medication adherence, or whether the patient obtains a newly prescribed medication in the first place.
The American Medical Association’s medication adherence guidance notes that approximately 25% of new prescriptions are never filled. That means a treatment plan can break down before treatment technically begins.
There is rarely one simple explanation.
A patient may leave an appointment intending to start treatment, but discover that the medication costs more than expected. Another may be concerned about side effects but feel uncomfortable raising those concerns during the visit. Someone managing several chronic conditions may find another prescription difficult to incorporate into an already complicated medication schedule. Transportation, pharmacy hours, prescription availability, uncertainty about where the prescription was sent, and competing demands at home or work can create additional friction.
This is why adherence should not automatically be interpreted as a question of patient motivation or commitment. Often, it is a question of whether the treatment plan works in the context of the patient’s actual life.
Why Patients Don’t Fill Their Prescriptions
Cost is one of the clearest examples of a barrier that can emerge before treatment begins. Recent KFF polling on prescription drug affordability found that roughly one-quarter of adults taking prescription medications have difficulty affording them. The problem becomes more pronounced as medication burden increases: 37% of adults taking four or more prescriptions reported difficulty affording their medications.
Affordability can affect adherence in multiple ways. Patients may delay filling a prescription, ask for a less expensive alternative, skip doses, take less than prescribed, or discontinue treatment. The CDC’s National Center for Health Statistics has similarly documented cost-related medication nonadherence, including delaying a prescription fill and taking less medication than prescribed.
But affordability is only part of the picture.
Patients may not fully understand why the medication is necessary, particularly when treating an asymptomatic condition such as hypertension or high cholesterol. Concerns about side effects may outweigh an abstract future benefit. A complicated regimen can be difficult to reconcile with work, caregiving, meals, sleep schedules, or other medications.
Even seemingly small logistical problems matter. A patient who does not know whether a prescription reached the pharmacy—or exactly which pharmacy received it—has another obstacle between the care plan and treatment, particularly if their mobility or ability to travel is limited.
Individually, these barriers can appear minor. Together, they illustrate why the prescribing encounter itself is an important opportunity to support adherence.
Set Patients Up for Success Before They Leave
A prescription represents both a clinical decision and an action the patient will need to carry out. Before prescribing, providers can therefore consider a practical question: Can this patient realistically follow this treatment plan?
Answering that question starts with communication.
Providers should explain why a medication is being recommended, its anticipated benefits, important risks or side effects, how it should be taken, and what patients should do if they experience problems. This discussion also creates an opportunity to identify concerns that could otherwise surface after the patient has left the practice.
The Agency for Healthcare Research and Quality’s SHARE Approach emphasizes shared decision-making through meaningful conversations about treatment benefits, harms, risks, alternatives, and what matters most to the patient.
That last point is critical. A clinically appropriate treatment can still encounter adherence problems when it does not align with the patient’s circumstances or priorities.
A brief conversation might uncover that a patient is worried about medication costs, has difficulty swallowing pills, works a schedule that makes multiple daily doses challenging, or previously experienced a side effect from a similar drug. Identifying those issues before prescribing gives the provider and patient an opportunity to discuss them rather than discovering the problem weeks later through an unfilled prescription or an unfavorable clinical outcome.
Patient Education Should Create Understanding, Not Just Provide Information
Providing instructions does not necessarily mean patients understand them.
The AHRQ’s patient education and engagement resources emphasize clear communication and health literacy strategies that help patients understand their conditions, choices, and role in healthcare decisions.
For medication adherence, that distinction is important. Patients need enough information to understand not simply what they have been prescribed, but why taking the medication matters.
Instead of viewing education as the final step before sending the prescription, practices can make it part of the prescribing workflow. That may include confirming that the patient understands the treatment goal, discussing major concerns, checking affordability when appropriate, and verifying that the selected pharmacy is convenient and accessible.
Providers can help patients understand the importance of medication adherence by making sure they leave the encounter with clear, practical answers to key questions:
- Why the medication is needed: Explain the condition being treated and how the medication fits into the overall treatment plan.
- What the medication is expected to do: Discuss the intended benefits and, when appropriate, when the patient might expect to notice an effect.
- How to take it correctly: Review the dose, timing, frequency, duration, and any relevant instructions involving food, other medications, or daily routines.
- What risks and side effects to watch for: Explain common or important side effects and what the patient should do if they experience a problem.
- Why consistency matters: Clarify the potential consequences of missed doses, stopping treatment prematurely, or otherwise not following the prescribed regimen.
- What to do when adherence becomes difficult: Encourage patients to contact the practice about cost, side effects, scheduling challenges, pharmacy access, or other barriers rather than changing or discontinuing treatment on their own.
- What happens next: Make sure patients understand follow-up expectations, including monitoring, refills, laboratory testing, or future appointments when applicable.
These conversations do not have to become lengthy counseling sessions. The objective is to identify barriers early enough to address them.
Standardized Workflows Make Adherence a Practice-Level Priority
Providers cannot anticipate every reason a patient might struggle with a prescription. Practices can, however, build processes that make common barriers less likely to go unnoticed.
Standardizing key elements of prescribing can help ensure that adherence does not depend entirely on how much time an individual provider happens to have during a particular visit.
A practice might incorporate prompts or procedures for confirming the preferred pharmacy, reviewing medication lists, discussing affordability concerns, providing understandable instructions, and documenting patient questions. For patients with complex medication regimens, workflows can also support medication reconciliation and more consistent follow-up.
Data can add another dimension. When practices have visibility into prescribing activity and patient information within connected clinical workflows, they may be better positioned to recognize patterns that deserve attention. Repeated medication questions, refill issues, or other points of friction can indicate opportunities to improve communication or processes.
The goal is not to eliminate provider judgment. It is to build a more reliable framework around it.
Technology Can Help Bridge the Gap Between Prescription and Pickup
Even a well-designed prescribing conversation cannot remove every obstacle that arises after a patient leaves the office. This is where technology can extend the adherence workflow beyond the visit.
Electronic prescribing already eliminates several steps associated with paper prescriptions, but practices can go further by considering what information patients need immediately after a prescription is transmitted.
RXnotify is designed around this transition. When a prescription is sent, the tool can automatically send a secure text notification to the patient’s mobile phone. Patients receive information confirming the prescription and pharmacy, helping reduce uncertainty about where the medication was sent. When a discount is available, the message can also include a prescription savings card that patients can present at the pharmacy.
The value of this type of functionality is less about adding another communication channel and more about removing friction at a critical point in the patient journey.
A patient who leaves an appointment with a new prescription may have heard a substantial amount of clinical information during the visit. A timely notification provides actionable information when the next step—obtaining the medication—becomes relevant.
For the practice, automation can provide that additional touchpoint without requiring staff to manually contact every patient after an electronic prescription is transmitted.
Better Adherence Requires Looking at the Entire Medication Journey
Medication adherence is not determined by a single reminder, conversation, or software feature. It develops across a series of decisions and interactions, beginning with the moment a medication becomes part of the patient’s treatment plan.
Practices can influence that journey by educating patients about benefits and risks, involving them in treatment decisions, discussing practical barriers, standardizing prescribing workflows, and using technology to make the next steps clearer.
This broader view also changes the question practices ask. Instead of focusing only on “Why didn’t this patient take the medication?”, teams can ask “Where did the process make it harder for this patient to succeed?”
That distinction matters because many adherence barriers are potentially addressable. Cost concerns can be discussed. Instructions can be clarified. Pharmacy information can be confirmed. Treatment plans can account for patient preferences and circumstances. Communication gaps between prescribing and pickup can be reduced.
The more practices can identify and address these issues before they become obstacles, the stronger the foundation for medication adherence becomes.
RXNT supports connected prescribing and patient engagement workflows designed to help practices manage the medication journey more efficiently, including RXnotify’s automated prescription notifications and savings information. To learn how these tools can support your practice and help create a more informed patient experience, feel free to contact us for more information.
