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It is important to measure medication adherence, however, there are several patient and health disparity adherence factors that are not accounted for in this performance measure, such as cost and medication side effects. The developer should share more evidence with regards to disparities and patient preferences to support this measure. Data shows that a positive physician-patient relationship can lead to more positive outcomes, but this performance measure does not assess that. Patient perception will influence medication adherence. The measure specifications should include exclusion criteria for lack of patient adherence due to the side effects of medication with documentation of alternative therapy. Finally, the performance measure intends to evaluate quality outcomes at the health plan level but is also currently included in accountability programs at the individual physician and group practice levels. Health plans can easily obtain detailed clinical management data from various information systems (e.g., claims, EHR, pharmacy), but physicians do not have access to the same information needed for effective medication management. Additionally, it is not in the physician’s control whether prescriptions are refilled.