Measuring Your Medication Adherence: A Practical Checklist

Getting your medicine on time doesn’t mean you’re taking it right. You might fill the prescription, keep the bottle on the counter, even set phone reminders-but if you skip doses, cut pills in half to save money, or stop when you feel better, your treatment isn’t working. And you’re not alone. More than half of people with chronic conditions like high blood pressure, diabetes, or cholesterol don’t take their meds as prescribed. The result? More hospital visits, worse health, and thousands of dollars in avoidable costs every year.

Why Adherence Isn’t Just About Remembering

Medication adherence isn’t about being forgetful. It’s about consistency over weeks, months, even years. The World Health Organization defines it as how closely your actions match what your doctor recommended. That means taking the right dose, at the right time, for the right length of time. Missing one dose here and there might not seem like a big deal, but over time, it adds up. For someone on a blood thinner, skipping a day can raise stroke risk. For someone with diabetes, inconsistent insulin use can lead to nerve damage or kidney failure.

The Three Phases of Adherence

Adherence isn’t one thing-it’s three. First, initiation: Did you take your first pill? Second, implementation: Are you taking it the way you’re supposed to, every time? Third, persistence: Did you keep going for the full course? Many people start strong but drop off after a few weeks. That’s why measuring adherence needs to look at more than just whether you picked up the prescription.

How to Measure Your Own Adherence

You don’t need fancy devices or clinic visits to track your adherence. Here’s a simple, practical checklist you can use at home-no apps required.

1. Keep a daily log: Write down each dose you take. Use a notebook, a sticky note, or even your phone’s notes app. Don’t rely on memory. If you skip a dose, note why-was it side effects? Cost? Forgot? This helps you spot patterns.
2. Do a weekly pill count: Every Sunday, empty your pill organizer and count what’s left. Compare it to how many you should have taken. If you’re missing more than one or two pills a week, something’s off.
3. Check your refill dates: Look at your pharmacy records. If you refill your blood pressure med every 28 days but your prescription is for 30 days, you’re probably taking it daily. If you wait 45 days between refills, you’re missing about 15 days a month. That’s 50% non-adherence.
4. Use the MARS-5 scale: Answer these five questions honestly:

• How often do you forget to take your medication? (1 = very often, 5 = never)
• How often do you intentionally skip doses? (1 = very often, 5 = never)
• How often do you stop taking it when you feel better? (1 = very often, 5 = never)
• How often do you cut or skip doses to save money? (1 = very often, 5 = never)
• How often do you take it exactly as prescribed? (1 = very often, 5 = never)

Add up your scores. 20-25 = high adherence. 15-19 = moderate. Below 15? You’re at risk. This isn’t a medical test-but it’s a wake-up call.

What the Numbers Really Mean

Doctors and insurers use metrics like Proportion of Days Covered (PDC) to measure adherence. PDC looks at how many days you had your medicine available over a set time-usually a year. If you’re on a 30-day supply and refill on time, you’re at 100%. If you wait 40 days to refill, your PDC drops to 75%. The standard for good control? 80% or higher. That’s the threshold used by Medicare, insurers, and clinical guidelines.

But here’s the catch: PDC doesn’t know if you actually took the pills. You might have bought them, but left them in the drawer. That’s why combining PDC with your own log gives you the full picture.

What Doesn’t Work

Don’t trust yourself to remember. Studies show people overestimate their adherence by 30-50%. One study found electronic monitors caught non-adherence in 58% of patients-while self-reports only caught 32%. That means nearly half the people who think they’re doing fine aren’t.

Also, don’t rely on pharmacy refill records alone. If you get prescriptions from multiple pharmacies-common among older adults or those on multiple meds-your data is fragmented. One study found over a third of Medicare users use three or more pharmacies. That means your doctor doesn’t see the full picture.

How to Fix It

If your checklist shows you’re falling short, here’s what to do next:

• Talk to your pharmacist: They can simplify your regimen-switch from three pills a day to one combo pill. They can also help you find low-cost options or patient assistance programs.
• Use a pill organizer: Not just any one-use one with compartments for morning, afternoon, evening, and night. Set a daily alarm on your phone that plays a sound you can’t ignore.
• Link meds to habits: Take your pill after brushing your teeth, with breakfast, or right before bed. Habit stacking works better than reminders.
• Ask for help: If cost is the issue, say it out loud. Many clinics have social workers who can connect you with free or discounted meds. If side effects are the problem, don’t stop-ask for an alternative.
• Use the BATHE method when talking to your doctor: Tell them the Background (what’s going on), your Affect (how you feel), the Trouble (what’s stopping you), how you’re Handling it, and let them show Empathy. This approach increased honest disclosure by 47% in a Mayo Clinic trial.

What’s New in 2026

Smart pill bottles are getting cheaper. Companies like AdhereTech now make bottles with cellular chips that text you if you miss a dose-and send alerts to your doctor if you go days without opening it. AI tools are also getting better. One system analyzed EHR data and predicted who’d miss doses with 87% accuracy. That means your doctor might soon know you’re struggling before you even say anything.

Medicare Part D plans now get bonuses up to $1,200 per person for keeping patients on their meds. That’s why more pharmacies are calling patients directly, offering free delivery, or even sending a nurse to check in.

Final Check: Your Adherence Scorecard

At the end of each month, ask yourself:

• Did I refill on time? (Yes/No)
• Did I count more than 2 missing pills? (Yes/No)
• Did I skip a dose because of cost, side effects, or forgetting? (Yes/No)
• Did I tell my doctor or pharmacist about it? (Yes/No)
• Did I use my pill organizer every day? (Yes/No)

If you answered “No” to more than two of these, your adherence is slipping. Don’t wait for a hospital visit to fix it. Talk to someone. Start small. One pill a day, taken right, is better than ten taken half the time.

Next Steps: What to Do Today

1. Grab your pill bottles and count how many you have left in each. Compare it to your prescription length. 2. Write down the last time you missed a dose-and why. 3. Call your pharmacy. Ask if they can combine your meds into one pill or send reminders. 4. Set a weekly alarm to check your pill box every Sunday. 5. Next time you see your doctor, say: "I’ve been having trouble keeping up with my meds. Can we talk about how to make this easier?" You don’t need to be perfect. You just need to be consistent. One step at a time.