Medication Adherence Agent

The work it takes off your plate

Non-adherence silently undermines chronic disease control, quality measures, and total cost of care. Refill gaps and low proportion of days covered (PDC) are often discovered only after complications. Pharmacy and care teams lack unified visibility across claims, fills, and clinical outcomes, and outreach is reactive. The Medication Adherence Agent detects non-adherence patterns from refill and claims data and orchestrates targeted pharmacist and patient outreach before gaps become clinical events.

How it works

The agent continuously analyzes fill history and claims to compute adherence metrics, identifies patients at risk of non-adherence, segments barriers, and triggers outreach workflows for pharmacists, care managers, and patients with tailored interventions and follow-up.

1. Step 1: Monitor Refills and Claims

   • Ingest retail, mail-order, and specialty fill events plus PBM claims
   • Calculate PDC, MPR, and days late for targeted therapeutic classes
   • Link adherence metrics to diagnosis and quality measure attribution

   Result: Near real-time adherence profiles are available for priority cohorts.

2. Step 2: Detect Non-Adherence Patterns

   • Flag declining PDC, delayed refills, and therapy abandonment
   • Segment by disease state (e.g., diabetes, CHF, hypertension, asthma)
   • Predict near-term gap risk using utilization and social signals

   Result: Patients at risk are prioritized for proactive outreach.

3. Step 3: Drive Pharmacist and Patient Outreach

   • Assign tasks to clinical pharmacists or adherence teams
   • Trigger patient reminders via SMS, app, or call center
   • Offer interventions: sync fills, 90-day supply, cost assistance, counseling

   Result: Patients receive timely, barrier-specific adherence support.

4. Step 4: Track Outcomes and Close Gaps

   • Record outreach disposition and barrier codes
   • Monitor subsequent fill behavior and PDC recovery
   • Report impact on HEDIS/STAR and chronic care metrics

   Result: Adherence interventions are measured and continuously refined.

Why use it

• Proactive Gap Closure. Intervenes before refill lapses become clinical failures.
• Pharmacy-Led Impact. Puts pharmacists at the center of adherence recovery.
• Multi-Channel Engagement. Reaches patients through preferred communication paths.
• Quality Measure Lift. Supports PDC-related HEDIS and STAR performance.
• Barrier Intelligence. Captures cost, side-effect, and access reasons for targeted help.