Adherence to Antipsychotic Medications For Individuals with Schizophrenia
Percentage of individuals at least 18 years of age as of the beginning of the performance period with schizophrenia or schizoaffective disorder who had at least two prescriptions filled for any antipsychotic medication and who had a Proportion of Days Covered (PDC) of at least 0.8 for antipsychotic medications during the performance period.
Last updated: January 15, 2026
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📖Clinical Rationale
A large body of evidence has shown that antipsychotic medications (APMs) are effective in treating acute psychotic exacerbations of schizophrenia and in reducing the likelihood of relapse. Guidelines from the National Institute for Clinical Excellence (NICE) and the American Psychiatric Association (APA) emphasize the importance of treatment adherence and uninterrupted antipsychotic regimens to prevent symptoms and relapse [1,2].
However, some studies estimate that the rate of adherence to APMs among patients diagnosed with schizophrenia is about 50 percent, much lower than the 80 percent threshold often used to define adherence [3]. Factors associated with poor medication adherence include greater symptom severity, a more frequent dosing regimen, poor insight, and a more negative attitude towards drugs [4,5].
Some studies have also identified Latino and African American ethnicity, lack of housing, and co-occurring behavioral health and substance use conditions as predictors of increased nonadherence to antipsychotic medications [6]. This measure describes the degree of compliance or non-compliance with recommendations related to medication adherence among patients with schizophrenia and, in doing so, has the potential to improve management of schizophrenia.
This measure addresses a Healthy People 2030 goal to increase the proportion of adults with serious mental illness who receive treatment [7]. Although the prevalence of schizophrenia in the adult American population is less than 1%, this population has a higher risk of premature mortality than the general population [8]. The estimated average potential life lost is 28.
5 years for individuals with schizophrenia compared to the general population [9]. The overall U.S. cost of schizophrenia has been estimated at $155.7 billion annually with direct health care costs of $37.7 billion [10]. Antipsychotic medications have proven to be effective in treating this disease. Additionally, adherence to APMs has been associated with lower rates of preventable diabetes hospitalizations and lower rates of emergency department utilization among patients with schizophrenia [11,12,13].
📝Clinical Recommendations
The 2014 NICE Guideline on Treatment and Management of Psychosis and Schizophrenia in Adults recommends that “for people with an acute exacerbation or recurrence of psychosis or schizophrenia, offer oral antipsychotic medication in conjunction with psychological interventions (family intervention and individual [cognitive behavioral therapy])”. The guideline also recommends to “consider offering depot /long-acting injectable antipsychotic medication to people with psychosis or schizophrenia who would prefer such treatment after an acute episode [or] where avoiding covert non-adherence (either intentional or unintentional) to antipsychotic medication is a clinical priority within the treatment plan”.
These recommendations are found on pages 381 and 382 of the 2014 NICE Guideline under the Clinical Practice Recommendations, Treatment of Acute Episode and Promoting Recovery sections, respectively [2]. The American Psychological Association (APA) updated its guidelines for treating patients diagnosed with schizophrenia in December 2019. The following statements pertaining to the use of antipsychotic medications were included in the 2019 guidelines with a grade of 1A, indicating that there was high quality evidence to support them: The APA recommends that patients with schizophrenia be treated with an antipsychotic medication and monitored for effectiveness and side effects.
The APA recommends that patients with schizophrenia whose symptoms have improved with an antipsychotic medication continue to be treated with an antipsychotic medication [1].
📋Implementation Notes
This measure contains one strata defined by a single submission criteria. This measure produces a single performance rate. For the purposes of MIPS implementation, this patient-process measure is submitted a minimum of once per patient for the performance period. The most advantageous quality data code will be used if the measure is submitted more than once.
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