Scenario: You and your doctor have discussed the pros and cons of a particular prescription medication, and you’ve agreed that it’s in your best interest to take the drug. So my question is, are you actually taking the drug as prescribed?

Or do you sometimes forget…or take the wrong dose…or realize that you’ve run out only when you’re staring into the empty bottle? Unfortunately, the majority of people fall into this category. In fact, a recent survey found that most Americans get pretty bad report cards when it comes to managing their medication use—and one in seven gets a dismal grade of F.

That can have some very dangerous consequences, depending on the medication in question. For instance, skipping a dose of a painkiller might lead only to some increased discomfort…but running out of your blood thinner can increase your risk for a potentially deadly stroke, heart attack or pulmonary embolism.

About 30% of American adults are living with chronic medical conditions, and they take an average of four prescription drugs each. These people are the ones at greatest risk if they don’t take their medications properly. That’s why the new survey results are so worrisome.


The National Community Pharmacists Association sponsored a telephone survey of 1,020 adults age 40 and older who had received a prescription for a chronic health condition. Respondents were asked nine questions about how well they adhered to their prescriptions, plus other questions about their health-related attitudes and behaviors.

Here’s how the participants did on adherence, based on self-reported behaviors in the previous 12 months…

  • 57% missed a dose.
  • 30% forgot whether they had taken their medication.
  • 28% were late to refill a prescription.
  • 22% took a lower dose than prescribed.
  • 20% failed to fill a new prescription.
  • 14% stopped a prescription early.
  • 7% took an old medication for a new problem without consulting a doctor.
  • 6% took a higher dose than prescribed.
  • 5% took medicine that had been prescribed for someone else.

Participants’ responses were then converted to the standard report card grading system of zero to 100—with zero meaning that a person was noncompliant in all nine areas, and 100 meaning that the person was completely compliant. Any score in the 90s earned an A…in the 80s earned a B…in the 70s earned a C…in the 60s earned a D…and a score of less than 60 earned an F.

The grades the survey respondents got…

A—earned by 24% of respondents.

B—earned by 24%.

C—earned by 20%.

D—earned by 16%.

F—earned by 15%.

In other words, the average grade was a mediocre C+…fewer than half of respondents earned an A or a B…and one-third got a D or an F. One in seven—the equivalent of more than 10 million American adults—got a failing grade! And considering the fact that some people are reluctant to admit when they don’t do what they are supposed to do, the actual rates of nonadherence are probably even worse than reported.

The researchers also analyzed various factors that helped respondents score higher. These factors may help you, too. Here are the six key predictors for medication adherence, in order of significance…


1. Having a personal connection with a pharmacist or pharmacy staff. People who reported that someone at their pharmacy “knew them pretty well” generally got better grades than those who lacked this personal connection—and it’s interesting that this was the most significant factor. What this means for you: Consider using a local pharmacy rather than a mail-order pharmacy if you have trouble taking your meds as prescribed.

2. Affordability of the medication. Those who said that their medicine was very affordable scored, on average, a full grade higher than those who had a hard time affording it. Best: If you have concerns about medication costs, ask your doctor if there are more economical options, such as generic versions instead of name-brand drugs.

3. Continuity with a health-care provider. Respondents who said that they always saw the same doctor scored higher than those who tended to see different doctors from visit to visit. Helpful: Try to establish an ongoing relationship with one primary care doctor.

4. Perceived importance of adherence. People who believed that it’s extremely important to take medication exactly as prescribed understandably scored higher. Recommended: If you are skeptical about your medication’s importance, be open in discussing your doubts with your doctor.

5. Knowledge about their health. People who felt well-informed about their health did better than those who knew less about their conditions. What to do: If you have a chronic medical condition, research it well—the more you know, the better you’re likely to be at managing the condition, including with proper medication use.

6. Side effects of medication. Average scores dropped by a full letter grade among people who reported drug side effects, compared with those who had no side effects—though, surprisingly, this ranked lowest among the six key factors that predicted medication adherence. Lesson: If troublesome side effects make you reluctant to take your medication, talk to your doctor about alternatives that might have fewer side effects.

Helpful: Many respondents said that they simply forgot to take their meds. To prevent this, use a pill container with separate compartments for each day or with multiple compartments for each day. You will also be prompted to refill your prescription when you realize that you don’t have enough pills to fill the box. Some high-tech pillboxes have timers or alarms on them to give you an audible reminder. For lots of additional tips, see “More on Medication Management,” above.