New evidence shows that how medicines reach patients may be just as important as what is prescribed, with delivery systems emerging as a key driver of adherence, affordability, and long-term health outcomes.
Review: Delivery models to improve adherence to medicines for chronic diseases in primary care. Image Credit: ako photography / Shutterstock
In a recent review published in The Lancet Primary Care, a group of authors examined how different medicine delivery models influence access, affordability, and adherence to long-term treatment for chronic diseases across diverse health systems. The review emphasizes that no single delivery model is universally optimal and that effectiveness depends on context, regulation, patient needs, and local reimbursement and infrastructure constraints.
Chronic Disease Burden and Adherence Challenges
Nearly 75 percent of deaths worldwide are caused by chronic conditions such as cardiovascular disease and diabetes, which the World Health Organization (WHO) classifies as non-communicable diseases requiring long-term or lifelong management rather than strictly lifelong treatment in every case. Yet millions of people struggle to take prescribed medicines regularly. While missed doses are often attributed to patient behavior, real-life barriers such as high costs, long travel distances to pharmacies, fragmented health systems, short dispensing intervals, limited digital access, and reimbursement policies that may incentivize shorter prescription cycles play a major role.
Home delivery, automation, and expanded digital health services have created new opportunities, and interest in how medicine delivery systems influence adherence has grown. Rather than identifying a single best delivery model, the review highlights how different models perform under different health system conditions, with evidence varying by disease type, national regulation, and healthcare financing structures.
Why Delivery Systems Affect Daily Care
Medicines are effective only when people can access and take them regularly. For individuals with hypertension or diabetes, missed refills have been associated with poorer disease control, increased complications, hospitalization, and mortality, without establishing direct causation in every setting. Treatment success or failure is often influenced by delivery systems, including dispensing interval policies, access logistics, and financial barriers.
Traditional In-Person Pharmacy Pickup
Physical pharmacy pickup remains the most common delivery model worldwide. Patients visit community or hospital pharmacies to obtain prescriptions, enabling pharmacists to provide counseling, identify drug interactions, and support appropriate medicine use. In high-income countries, pharmacies often offer additional services, such as blood pressure checks and medication reviews, whereas in many low- and middle-income countries, they also serve as important first points of care.
This model also has limitations. Long travel times, waiting periods, and high charges may disrupt regular refills and reduce adherence. For example, Australian data cited in the review suggest that pharmacy dispensing-related charges accounted for just over 50 percent of antihypertensive medicine delivery costs, reflecting the influence of reimbursement frameworks rather than total national healthcare expenditure.
Mail-Order Pharmacy Delivery Models
Mail-order pharmacies deliver medications directly to homes or workplaces, usually in 60- or 90-day supplies. This approach reduces travel time and may improve adherence, particularly for chronic conditions. Large organizations such as the United States Veterans Health Administration have demonstrated that centralized mail delivery can reduce costs while supporting large-scale distribution, although reported benefits vary across healthcare systems and patient populations.
Many adherence estimates in these systems rely on proxy measures such as prescription refill coverage, which indicate medicine possession rather than confirmed ingestion. Mail-order delivery also depends on reliable postal services and regulatory frameworks. Delays, lost shipments, and challenges with temperature-sensitive medicines, such as insulin, can disrupt regular intake.
Digital Pharmacies and Consumer Platforms
Electronic pharmacies expanded rapidly during the COVID-19 pandemic. Online ordering and home delivery are often combined with physical pharmacies to comply with regulations. Direct-to-consumer models integrate prescribing, dispensing, and delivery within a single platform.
Some direct-to-consumer services in the United States have reduced medication costs by eliminating markups and improving price transparency, attracting uninsured individuals facing high drug prices. The review stresses that counseling is not necessarily absent but must be intentionally integrated through digital consultation, pharmacist oversight, and regulatory safeguards to minimize risks such as counterfeit medicines or inappropriate prescribing. Safety outcomes depend on regulatory oversight, professional involvement, and digital literacy.
Automation, Drones, and Emerging Technologies
New delivery technologies are improving access in remote areas. Drones, smart lockers, and automated dispensing units can reduce waiting times and bring medicines directly to patients. In Africa, drones have successfully delivered vaccines, blood products, and emergency supplies.
Evidence supporting the routine delivery of chronic disease medicines through these technologies remains emerging rather than fully established. Cost, infrastructure, and regulatory complexity continue to limit widespread adoption, with most evidence derived from pilot programs and emergency logistics rather than broad chronic care implementation.
Physician-Based Medicine Dispensing
Physician dispensing allows doctors to provide medicines directly during consultations, bypassing separate pharmacy visits. This model can improve access in rural areas and reduce delays between diagnosis and treatment. Examples cited include Switzerland, the United Kingdom, the Netherlands, the United States, and China, with substantial variation in regulatory frameworks.
However, physician dispensing raises potential conflicts of interest, particularly in fee-for-service systems, where prescribers may benefit financially from dispensing. Similar incentives can exist in pharmacy-based dispensing, highlighting the importance of transparent regulation across all models. Salaried or publicly funded systems may mitigate some financial concerns.
System-Level Constraints and Policy Design
Medicine delivery models are shaped by national funding, regulation, infrastructure, reimbursement design, and digital capacity. Public systems often prioritize equity but may struggle with rapid innovation, while private systems may innovate quickly but inadequately serve lower-income populations. Hybrid models attempt to balance these goals but often face regulatory rigidity, legacy prescribing software defaults, and reimbursement rules that unintentionally limit longer dispensing intervals.
Evidence indicates that adherence is challenged by short dispensing intervals, high out-of-pocket costs, fragmented delivery systems, inconsistent adherence measurement methods, and limited global standardization of adherence definitions. The review emphasizes the need to distinguish system cost efficiency from patient affordability, which do not always align. Longer prescription durations, integration of digital support with human care, and alignment of financial incentives with patient outcomes may improve adherence.
The authors also emphasize inclusive digital transitions to ensure that older adults, rural populations, and individuals with limited digital literacy are not excluded. Environmental impacts, including packaging waste and transport emissions from delivery services, were identified as emerging concerns requiring further evaluation alongside clinical and economic outcomes.
Rather than promoting a single model, the review recommends flexible systems capable of meeting diverse patient needs, supported by strong governance, regulatory coordination, and international standardization of evidence.
Overall Conclusions and Implications
How medicines are delivered is as important as what is prescribed. Evidence suggests that delivery systems influence access, cost, and adherence in chronic disease care, although differences in adherence measurement and study design warrant cautious interpretation. Traditional pharmacy dispensing remains common, while mail-order services, digital pharmacies, automation, and physician dispensing are all viable options when properly regulated and integrated.
Systems that reduce costs, minimize travel burdens, maintain patient support, and balance efficiency with equity are more likely to sustain long-term treatment. Strengthening delivery infrastructure, regulatory frameworks, patient-centered design, and internationally harmonized adherence measurement can improve health outcomes and reduce the global burden of chronic disease.
Journal reference:
Diaz, R. R., Satheesh, G., Moran, A. E., Perel, P., Rodgers, A., & Schutte, A. E. (2026). Delivery models to improve adherence to medicines for chronic diseases in primary care. The Lancet Primary Care. 2(1). DOI: 10.1016/j.lanprc.2025.100074 https://www.thelancet.com/journals/lanprc/article/PIIS3050-5143%2825%2900074-3/fulltextÂ