Abstract: A medication adherence and monitoring system and method for use with pill packet dosing is provided. The system is configured to mount on a medication reservoir that stores a stream of pill packets. The system utilizes a processor in conjunction with an optical scanner, to read scannable codes on the stream of pill packets to configure the system and track extraction of the pill packets from the reservoir when they pass by the optical scanner as the pill packets are extracted from the reservoir through an opening in a housing that spans or covers a storage container for the pill packets. The system further provides prompting and feedback for the extraction of the pill packets while monitoring compliance with the dosage schedule for the user.