As a research fellow in the 1980s, I developed an adherence measure that used prescription refill records to calculate the proportion of medications that a patient filled over time.¹ Many similar measures of refill adherence have since been validated for pharmacoepidemiology and health services research.² In 2012, Medicare adopted 1 of these measures for several medication classes to assess the quality of outpatient care, and began offering payment incentives to encourage health plans to improve adherence.³

Almost 40 years later, I now take 2 medications that Medicare includes in its adherence metrics. Being a researcher to the core, I count my pills and track the timing of my refills. I can say that I have been approximately 98% adherent (with very narrow confidence intervals) over the years. Despite my consistent adherence, my health care system began to send me email reminders when my refills were due. I found these reminders to be unnecessary, and reflexively deleted them. In the past year, however, I have received increasingly urgent text messages and automated telephone calls from the pharmacy in my health care system with offers to help me fill my medications.