Introduction The subject of medication adherence is a timeworn topic. It seems to have confounded practitioners and policy makers alike because, for all the effort and resources thrown at the subject matter, people are still nonadherent to their prescribed medication regimens. Adherence, in the purest sense, is a simple act of taking a medication as prescribed. Trying to impact adherence can be as simple as getting to know patients and their relationship with their medication. Therefore, the act of measuring adherence as a means to define the quality of pharmacy care should simply reflect how well a clinician or health system has met patients’ needs. What has resulted from all this research is a large amount of information about the variety of changes that can affect adherence in only a slight way. Attempting to impact adherence has become a tangled mess, each player in health care working in their own, uncoordinated way to improve adherence. As a quality measure, adherence has not been fully developed to represent all the aspects of adherence these players are trying to impact.