OBJECTIVES:  To compare medication adherence and discontinuation in patients with schizophrenia who initiate a long acting injectable antipsychotic (LAI) to those who change to a different oral antipsychotic. METHODS:  This retrospective cohort analysis used the Truven Health Analytics MarketScan® Medicaid claims database. Of the identified adult patients (≥18 years) diagnosed with schizophrenia, two mutually exclusive cohorts were created: LAI cohort, or patients initiating LAI therapy between 01/01/2013 and 06/30/2014 (the identification (ID) period); and oral cohort, or patients who changed to a different oral antipsychotic mono therapy during the ID period. The first day of initiating an LAI or changing oral therapy was the index date. Primary outcome measures were medication adherence (proportion of days covered) during the 1-year post-index period and medication discontinuation (continuous medication gap ≥ 60 days) of the index LAIs or orals during the entire follow-up period. General linear Cox regression models were used to estimate medication adherence and time to medication discontinuation. Models adjusted for patient demographic and clinical characteristics, baseline medication, and baseline emergency department visits or hospitalizations. RESULTS:  The study sample consisted of 2,861 (50.7%) LAI initiators and 2,777 (49.3%) oral monotherapy users. Compared with the oral cohort, LAI initiators had better medication adherence (adjusted mean: 0.55 vs. 0.50, p<0.001). LAI initiators also had a lower discontinuation rate (72.5% vs. 77.2%; p<0.001) and a significantly longer time to medication discontinuation than the oral cohort. The median time to discontinue index LAI was 196 days, compared with 123 days for the oral cohort (p<0.001). The oral cohort discontinued their index treatment at a higher rate than the LAI cohort (hazard ratio: 1.20; p<0.001). CONCLUSIONS: This real-world study suggests that patients with schizophrenia initiating LAIs had better medication adherence and lower discontinuation risk than patients who changed to different oral antipsychotic monotherapy.