Healthcare costs are always a point of concern, regardless of whether you’re a patient, a healthcare provider, a pharmacy, or an insurer. The race to keep treatment costs affordable and accessible is never-ending, even with the pace of technological innovation the sector has benefitted from in recent years. Despite all of that progress and investment, there’s one factor that continues to influence both healthcare costs and outcomes, and it’s the one element that can’t effectively be automated away: the human element of medication adherence.
Put simply, medication adherence is the rate at which patients consistently take their prescribed medication, and while it obviously impacts the patients’ health outcomes, it also has a compounding effect on other healthcare costs down the line—including for employers and healthcare providers themselves. Unfortunately, non-adherence is a common problem with any number of potential causes from patients’ uncertainty about side effects, to costs, to simply forgetting, and these problems can come with severe repercussions.
Improving medication adherence rates is important; non-adherence costs the lives of as many as 125,000 Americans annually, and costs the healthcare systems hundreds of billions of dollars. Healthcare providers, pharmacies, and PBMs like AffirmedRx can encourage adherence through robust client support services that ensure patients’ prescription access, encourage member engagement, and offer robust prescription education. By encouraging medication adherence, the healthcare sector as a whole can both save costs and improve patients’ lives—everyone wins.
The Origins and Consequences Of Poor Adherence
There are many reasons a patient might not take their prescription medication as directed. Some may have been prescribed a new medication, and are hesitant to start taking it for fears of side effects or general uncertainty regarding its efficacy (or both). Others may hesitate to take their medication as instructed because the cost of the medication is a barrier, and so they either hold it in reserve until it’s critically necessary, or try to spread out their dosages. Some may simply be prone to forgetting for whatever reason, be it busy lives or a condition like ADHD. No matter the cause, the results of medication non-adherence can be dire.
“When people with chronic conditions such as cardiovascular disease do not take medication as directed, the repercussions can be severe,” says the American Heart Association. “For instance, not keeping blood pressure in check can lead to heart disease, stroke and kidney failure.”
There are a multitude of studies confirming that strong medication adherence is associated with improved clinical outcomes across the board, for both patients and providers. This is especially noteworthy for chronic disease patients, which make up more than one-third of adults; however, according to a 2025 study approximately half of patients with chronic conditions fail to adhere to medication recommendations, which leads to preventable morbidity, hospitalizations, and costs. The study also notes that it’s incredibly hard to track the precise rate of adherence—which makes it equally hard to find meaningful solutions.
“Research into medication adherence is complicated by the diversity of measurement methods and definitions, resulting in inconsistent outcomes,” the study says. “Accurate measurement is essential for clinical decision making and identifying effective interventions.”
When the total rate of medication non-adherence is as high as 75%, the costs add up fast. Aside from the estimated 125,000 deaths, between 33% and 69% of medication-related hospital admissions are due to poor adherence. The monetary consequences—both direct and indirect combined—run as high as $300 billion every year. The health consequences are elevated mortality, increased healthcare utilization, and other economic losses due to work absenteeism and presenteeism. Improving medication adherence can improve both patient health and economic stability, and should be made a priority.
A Spoonful of Solutions
There are ways to address these ongoing problems, and most of them start with education. A 2022 article recommends investments in improved communication and education between providers and patients regarding their care, and building systems to ensure that communication goes both ways. Patients are more likely to adhere to their medication recommendations when their challenges with doing so are heard and resolved, in whole or in part. They’re also more likely to do so when they are fully informed about not just what the medication is supposed to do for them, but the consequences of not doing so—an easily-closed oversight in provider-patient education. Other potential solutions include effective advocacy, the adaptation of medications to alternative forms (fluids, pill sizes, bioavailability), and stronger communication between providers, patients, and pharmacies.
“By their proximity to the community, community pharmacists can facilitate a line of communication to patients with dignity, respect, and understanding as fulcrums,” the article says. “Providers are instrumental in encouraging compliance by increasing awareness, serving as worthy role models, and sharing personal testimonies if any.”
The patient-centric, highly-communicative approach has consistently borne fruit in a number of case studies. For example, the Pharmacy Benefit Manager AffirmedRx stands out for their patient-centered business model, backed by robust transparency and communication standards and made fundamental as part of its structure as a Public Benefit Corporation. AffirmedRx’s team of Patient Care Advocates (PCAs) is dedicated to helping customers manage and acquire their prescriptions, and one specific case study stands out.
One of the common reasons for poor medication adherence is that the medication itself became inaccessible, either for reasons of cost or because a specific formula was no longer produced. This was the case for one of AffirmedRx’s members, who was managing her seizures with a specific brand drug—which was suddenly no longer on formulary. What’s worse was that the alternative medication had the potential to trigger seizures rather than prevent them. The PCA representative’s advocacy helped her secure a long-term override to ensure the patient’s adherence, largely as a result of a concerted effort to communicate consistently and respect the member’s concerns.
“This lasting solution undoubtedly has led to cost-savings in terms of avoiding the downstream effects of not having medication critical to the member’s health,” according to AffirmedRx. “Without this PCA-driven solution, the member could have suffered avoidable seizures, emergency room visits, or hospitalization—all of which can cause financial stress for the member and her health plan.”
