Medication nonadherence costs the US an estimated $290 billion every year, yet most efforts to fix it still focus on patient behavior: better reminders, better apps and better compliance strategies. But these approaches overlook a critical, and largely structural, truth: you can’t improve adherence at scale in a country where nearly half of all counties now qualify as pharmacy deserts. As traditional retail pharmacies close across rural and urban communities alike, millions of Americans are being pushed farther away from essential medication access. And as distance increases, adherence declines. It’s a predictable failure of infrastructure, not individual willpower.
Many readers understand this well: when an industry faces systemic disruption, the winners are the ones who rethink the model, not the ones who optimize yesterday’s workflows. It’s time to break down the myths holding the pharmacy sector back, and the emerging realities shaping a new, tech-enabled approach to adherence that blends operational redesign, AI innovation and equity-focused care.
Myth 1: “Adherence is a patient problem; just send better reminders.”
Reality: Nonadherence is a systems problem tied to access, affordability, and friction, not forgetfulness. For years, adherence solutions centered on reminders: text alerts, pill caps, push notifications. But reminders only address one small slice of the problem. The real drivers are structural, including long travel distances to reach a pharmacy, inconsistent hours and limited transportation, high out-of-pocket costs and poor price transparency. Fragmented provider-pharmacy communication and lack of counseling when side effects or confusion arise are additional factors. When 16 million Americans live more than an hour from the nearest pharmacy, adherence becomes both a logistical and economic challenge. Businesses and health systems are beginning to respond with infrastructure-level solutions such as home delivery and same-day courier fulfillment, locker pickup and community access hubs. Additionally, they’re exploring telepharmacy services that bring pharmacist expertise to any location and putting in place tools to bring predictive analytics that flag risk before the refill is missed. This is not about nudging patients into compliance, it is about building a system that makes adherence feasible. We’re at a tipping point where technology can make geography matter less, without losing the human touch patients crave.
Myth 2: “Telepharmacy widens disparities.”
Reality: Telepharmacy reduces disparities when designed for the least-connected, not the most tech-savvy. A common critique is that virtual pharmacy services disadvantage the elderly, low-income consumers or those without smartphones. And that risk is real, but only if telepharmacy is designed like a consumer tech product. Equity-centered models do the opposite. They provide SMS-based experiences that work on any phone and include multilingual and low-literacy interfaces. Telephone support is positioned as a first-class channel, not an afterthought, and human fallback pathways exist for every digital interaction. That combined with offline logistics like mail delivery and pickup lockers helps to expand access for everyone. With this, populations traditionally left behind by digital health are actually better served, especially in communities where brick-and-mortar pharmacies have closed. For businesses and payers, this creates a powerful equation: equity and scale can coexist when designed intentionally. Equity by design means building solutions that work for everyone, not just those with the latest devices.
Myth 3: “AI in pharmacy is futuristic.”
Reality: AI is already redefining the pharmacy workflow, unlocking pharmacist capacity and lowering operating costs. AI’s role in pharmacy is often described as “emerging,” but in reality, its operational value is already measurable. For example, intelligent verification and computer vision are already reducing manual dispensing workload, and AI-powered task triage is helping to sift through calls, faxes and messages so pharmacists can focus on clinical needs. Clinical decision support tools are helping to monitor patterns in labs, interactions and adherence during patient counseling. And workforce optimization models can predict volume and reduce burnout among pharmacists. In an industry with shrinking margins and workforce shortages, AI’s ability to shift pharmacists from low-value tasks to high-impact clinical care is not just disruptive, it’s essential.
Myth 4: “Predictive analytics just identify who already missed doses.”
Reality: Next-gen analytics detect silent risk long before nonadherence occurs, and that’s where ROI is unlocked. While traditional adherence metrics are retrospective and identify a problem only after it has happened, modern analytics can identify upstream signals. They can look at things like on-time fills without timely refills, new-to-therapy abandonment patterns, recent regimen changes correlated with confusion, and cost-driven switching or medication avoidance, as well as social determinants that correlate to risk. For payers and health systems operating under value-based contracts, the ability to intervene before nonadherence results in complications, ER visits or hospitalizations is the difference between financial loss and meaningful impact. The most significant industry shift underway is philosophical: moving from compliance, i.e. getting patients to follow orders to empowerment, i.e. equipping them to manage their health confidently. Empowerment models in pharmacy care combine personalized nudges based on actual patient behavior with culturally competent education and seamless access to services, whether digital or in-person. They ensure pharmacists are involved earlier in the care process and prioritize human-centered support throughout every digital interaction, making the patient experience both supportive and accessible.
Behavioral science shows that adherence improves when systems adapt to patients, not the other way around. This shift isn’t just good clinical practice, it’s a business imperative. Better adherence reduces hospitalizations, improves chronic disease management and strengthens patient loyalty.
Photo: Volha Rahalskaya, Getty Images
Asher Perzigian is a recognized leader in commercializing and scaling innovative business transformation programs. Asher works with some of the leading healthcare providers, payers, vendors, and life sciences organizations in North America, and is responsible for Accenture’s relationship with one of the firm’s largest and most complex provider and care delivery clients. Asher lives in Chicago with his wife, son, and daughter and enjoys live music, hockey, running, and spending time with his large extended family. Asher is co-host of the Mavericks in Healthcare: Chronicles of Innovation Podcast Series.
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