Medication Adherence Agent
Detects non-adherence patterns from refill and claims data and drives pharmacist and patient outreach.
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
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.
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
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
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
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