Medication Management and the Myth of Patient Empowerment
- carbesman
- Oct 22
- 6 min read
Updated: Oct 28
When reminders don't solve the problem, and when they do
Paul Schrimpf, Christine Arbesman
All around you, Healthcare leadership continues to lean on familiar solutions: more education, more empowerment, more reminders to improve adherence. It sounds polite, nonthreatening, and promising. But it’s also a comfortable excuse that obscures a deeper, systemic failure. Because the truth is: medication adherence—our most basic measure of patient engagement—remains stubbornly low. Despite decades of well-meaning interventions, the problem persists. This isn’t a patient failure. It’s a system failure.
When a patient doesn’t refill or take a vital medication, it’s usually because something in the system broke, not because they forgot, misunderstood, or refused. The journey is complex. A clinician writes a prescription but may not know if it’s covered or whether prior authorization is required. The insurer or pharmacy benefit manager might delay approval. The patient arrives at the pharmacy and encounters an unexpected cost or a denial. Or they never make the trip at all, overwhelmed by the process. Each handoff introduces risk. The fact that 20 to 30 percent of new prescriptions are never filled is not a problem solved by reminders. It’s a sign that the system is filled with invisible steps that work against the patient.
As Michael Ho, MD, who led a large pragmatic trial on text-message reminders, observed, “It’s unclear—and under-studied—whether text message reminders are effective for a sustained period.” In other words, reminders might prompt short-term action, but they rarely address the root causes that make adherence difficult in the first place.
If we cannot get prescribing-to-adherence right, we should not expect patients to sustain more complex behaviors such as diet, exercise, and follow-up care. Medication adherence is our canary in the coal mine for adherence overall: it shows whether the system is fundamentally usable or fundamentally flawed.
Healthcare executives often default to education and reminders because they seem like a safe bet. “Let’s build more patient literacy campaigns,” they say. Or, “Let’s send more messages so they never forget.” That approach assumes patients can navigate an opaque system if only they try harder. And what’s even tougher for executives to admit is that the problem isn’t someone else. It’s them.
Dr. Colin Banas, Chief Medical Officer at DrFirst, nails this problem: “One of the biggest problems doctors have when writing a prescription is understanding if it’s covered. What’s it going to cost? Does it need a prior auth? … A lot of times we’re flying blind.”
It’s not the steps, it’s the obstacles
What we need is a shift in mindset: from empowering patients to designing for ease. The greatest act of patient respect is not telling them what to do, but removing the friction that forces them to fight the system at every turn.
What does that look like in practice? It means giving clinicians real-time visibility into coverage and cost before they prescribe. It means building systems that can predict when prior authorization is needed and start that process automatically. It means letting patients know in advance what they’ll pay at the pharmacy, so there are no surprises. It also means fulfilling prescriptions through delivery or dose packaging, so patients don’t face unnecessary trips. And when reminders are needed, they should be specific, timely, and limited. Not constant notifications that overwhelm more than they help.
Similar frustrations appear even in lower-resource settings. Kebede Deribe from the London School of Hygiene & Tropical Medicine found that health system barriers limited clinicians’ ability to act on reminders and follow case management guidelines. The problem wasn’t the reminders themselves. It was the environment that made effective response impossible.
By integrating real-time clinical and benefit data into the workflow, prescribers can instantly see if a drug is covered, whether prior authorization is required, and what lower-cost alternatives exist. If an electronic prior authorization (ePA) is needed, the system can begin the submission automatically within the workflow instead of relying on manual steps. These smart back-end systems are not optional extras. They are essential infrastructure designed to reduce failure points and accelerate therapy initiation.
The benefit of removing unnecessary steps is very real. In one of DrFirst’s partnerships, a transparency tool gave providers access to actual out-of-pocket costs and benefit details within the ordering workflow, easing the burden on patients. This clarity alone reduced surprise prescription abandonment.
The health system also used personalized SMS outreach linked to prescriptions at the time of prescribing. These messages were associated with a 19 percent increase in filled prescriptions and a 6 percent reduction in 30-day readmissions among patients who engaged. Outcomes like this are not driven by education or reminders alone. They depend on providing clinicians and patients with actionable insights. Not just in real time, but at the right time.
Transparency and clarity are different things
No one needs another explanation of how complex healthcare is. Yet, many healthcare executives mistakenly believe that transparency is simply about explaining complexity. Explaining complexity rarely leads to clarity. And clarity is what people really want when they ask for transparency.
Consider price comparison platforms. Doug Hirsch, Co-CEO of GoodRx, said, “GoodRx actually is not a pharmacy. We don’t put pills in bottles and sell them. There’s not a problem with that. The problem is that too many patients leave the doctor’s office with no sense of what their prescriptions will cost at the pharmacy.”
Put simply, GoodRx provides clarity that removes uncertainty in patients’ decision-making and reduces abandonment. Some call companies like GoodRx price-transparency companies, but they are really price comparison companies. They don’t explain how or why drugs are priced a certain way. They simply show patients where the lowest price is.
That’s what most people actually want. They don’t care how pharmacy benefit managers work; they just want to know where to go for the lowest drug prices. These changes don’t rely on education or persuasion. They rely on real-time insight and removing ambiguity.
This is not to discard education or reminders entirely
Information remains important, especially for high-risk patients, complex medication regimens, or ongoing therapy persistence. However, when reminders compete with hidden costs, authorization delays, or logistical challenges, reminders often fail. You cannot remind your way past poor system design. Relevance and context are essential. Overwhelming reminders can create confusion instead of clarity.
Education and reminders should play a supporting role, useful when the path is already clear. The main focus should be system design. That’s where real progress happens.
Some critics will point out that payers and pharmaceutical regulations add layers of complexity beyond what technology can solve. That is true. But innovation must work around these constraints. If prior authorization is unavoidable, then automate its logic, anticipate queries, and proactively surface decisions. If cost sharing is high, embed patient assistance tools and capture programs directly into the workflow.
Medication management is a bellwether for the entire healthcare experience
Medication adherence is more than just a metric. It is the clearest test of whether healthcare is truly usable. If patients cannot reliably fill and continue prescriptions in a system that claims to care for them, then none of our higher goals will succeed.
Returning to Dr. Banas’s point: flying blind is unacceptable. He calls for building infrastructure that gives clinicians clarity when prescribing. Accepting ambiguity, expecting patients to navigate a confusing system, and layering reminders on broken processes is inertia, not innovation.
The question for leadership is this: will you keep adding alerts and education campaigns, or will you redesign the fundamental parts of the journey so patients no longer have to fight to access their therapy?
Make the right thing the easy thing. Remove unnecessary steps. Clarify costs. Automate approvals. Deliver care without friction. That is how you shift adherence from a constant struggle to an expected outcome. When prescribing and adherence become seamless, other complex parts of healthcare stand a better chance of success.
Acknowledgements & Citations
This report draws insights and direct quotes from:
PharmD Live. “Medication Adherence in 2025: A Hidden Healthcare Crisis.” June 2025.
ISPOR. “Rethinking Medication Adherence: A Stakeholder Blueprint.” May 2025.
Ho, Michael, MD. “New JAMA Study Shows Text Messages Can Be Ineffective as Medication Refill Reminders.” University of Colorado Anschutz Medical Campus News, March 2025.
Malaria Journal. “The Effect of Mobile Phone Text Message Reminders on Health Workers’ Adherence to Case Management Guidelines.” 2018.
Banas, Colin, MD. “Closing the Gaps in Medication Adherence.” DrFirst Webinar, 2025.
HIT Leaders and News. “Dr. Colin Banas on Fixing the Medication Journey with AI, Automation, and Real-Time Data.” May 2025.
Fox Business. “GoodRx CEO Doug Hirsch: ‘GoodRx Actually Is Not a Pharmacy.’” November 2024.
IQVIA Institute. “Understanding the Use of Medicines in the U.S. 2025.” April 2025.
JMCP. “Impact of a Real-Time Prescription Benefit on Adherence and Cost Savings.” August 2025.