Do Digital Statin Reminders Improve Refills? What 14.4% vs 12.0% Means

Short answer: In a randomized trial of 20,604 adults who had recently fallen behind on statin prescriptions, 14.4% of those receiving added portal, text, or email outreach refilled within 14 days, compared with 12.0% receiving usual communication. The 2.3-percentage-point difference was statistically supported, but most participants still did not refill within two weeks.

• Online publication: August 29, 2026
• Journal issue: JAMA, November 3, 2026
• Setting: Kaiser Permanente Northern California integrated health system
• Participants: Adults with established or high risk for atherosclerotic cardiovascular disease and recent statin nonadherence
• Outcome measured: Prescription refill—not confirmed pill-taking, LDL reduction, or fewer heart attacks

What does 14.4% versus 12.0% compare?

Participants were randomly assigned to a secure patient-portal message, SMS/text message, nonsecure email, or usual communication. Messages said a statin refill was due, explained why regular use matters, and provided refill instructions or contact information.

Usual communication was not no contact. About 90% of participants were already enrolled in the health system’s automated pharmacy text reminders. The trial tested whether additional targeted outreach improved refill beyond that background program.

Within 14 days, 14.4% receiving any added digital outreach refilled, compared with 12.0% receiving usual communication. The adjusted risk difference was 2.3 percentage points (95% CI, 1.3 to 3.4), with an adjusted risk ratio of 1.20. A 20% relative increase therefore translated to roughly two additional refills per 100 people.

Did a second reminder help initial nonresponders?

Among 13,231 people who did not refill after the first digital outreach, a prespecified second randomization tested another message. Refill during the next 14 days was 13.0% with a second digital outreach and 10.4% with usual communication, an adjusted difference of 2.5 percentage points.

Switching from one communication channel to another did not outperform repeating the same channel: 13.2% versus 12.5%, with an adjusted risk ratio of 1.06 (95% CI, 0.94 to 1.17). The result suggests that timely follow-up may matter more than changing from text to email or portal messaging.

What happened by 28 days?

Cumulative refill through 28 days was 24.9% among people receiving any digital outreach and 21.2% with usual communication. The difference persisted, but roughly three quarters had still not refilled by 28 days. A reminder alone cannot resolve every barrier, such as cost, side-effect concerns, doubts about treatment, competing priorities, or difficulty accessing care.

What does this mean for an individual patient?

This was a health-system strategy for identifying and contacting people with a refill gap. It was not a trial telling people to restart a stopped statin whenever a message arrives. Someone who stopped because of muscle symptoms, pregnancy planning, liver disease, a medication interaction, or a clinician-directed change should confirm the next step with the prescriber or pharmacist.

Not receiving an outreach message does not mean a statin is unnecessary. Receiving one also does not replace individualized review of cardiovascular risk, laboratory results, medication history, and adverse effects.

Important limitations

• The primary outcome was pharmacy refill, not directly observed medication use.
• The 28-day follow-up cannot establish effects on LDL cholesterol, heart attack, stroke, or mortality.
• Eligibility required access to all study communication modalities, limiting generalizability to people with reduced digital access.
• The mean age was 54.8 years and only 15.3% had established ASCVD; results may differ in older populations, other health systems, and other countries.
• Longer-term 365-day outcomes were still ongoing, so persistence is unknown.

Primary sources

• JAMA original article: ADHERE-ASCVD randomized clinical trial
• PubMed abstract
• ClinicalTrials.gov NCT07522645