Medication adherence plays a critical role in determining patient health outcomes, yet it remains one of the most persistent challenges in healthcare. For example, in 2021, 57.9% of adults (age 18-54) took prescription medication, but reported not taking them as prescribed due to cost. Those adults combated prescription costs by skipping doses, taking less medication than prescribed, or delaying prescription refills.
When patients take medications exactly as prescribed, chronic conditions are more likely to remain controlled, complications can be avoided, and overall quality of life improves. Despite this, medication nonadherence continues to affect millions of patients, with a reported 125,000 preventable deaths annually and over $300 billion in avoidable healthcare costs each year.
The issue is rarely rooted in patient indifference or unwillingness. Instead, nonadherence is often the result of unaddressed and misunderstood barriers to medication adherence, barriers that quietly interfere with a patient’s ability to follow a treatment plan. Without identifying and addressing these challenges, even the most well-designed therapies can fail to deliver meaningful results.
Medication adherence is defined as “taking medications the way they are prescribed and following the plan developed by you and your health care team.” While this may seem straightforward, real-world adherence is influenced by far more than clinical instructions. Patients must navigate daily routines, financial pressures, side effects, and personal beliefs, all while managing complex health conditions.
Poor adherence is associated with worsening disease progression, higher rates of hospitalization, and increased mortality. It also places a significant burden on health plans and providers striving to meet quality benchmarks and improve population health outcomes. Addressing barriers to medication adherence is therefore not just a clinical concern, but a foundational component of effective, value-based care.
Understanding why patients struggle to follow their prescribed treatment plans is the first step toward improving health outcomes. These challenges are often complex and multifaceted, ranging from financial constraints to the logistical hurdles of daily life.
One of the most common and impactful barriers to medication adherence is cost. Out-of-pocket spending grew 5.9% to $556.6 billion in 2024. While prescription drug spending increased 7.9% to $467.0 billion in 2024. Even insured patients may struggle with high copays, deductibles, or formulary restrictions. For individuals managing multiple chronic conditions, medication expenses can accumulate quickly, forcing difficult financial decisions.
When cost becomes a barrier, patients often modify their behavior in ways that compromise their care. They may skip doses, delay refills, or stop taking medication altogether. At times, this may be done without informing their healthcare provider. These decisions are rarely made lightly; they’re often rooted in financial survival rather than a disregard for their health. Without open conversations about affordability, cost-related nonadherence can remain hidden until health outcomes decline.
Medication regimens can be difficult to manage, especially for patients prescribed multiple therapies with different dosing schedules and instructions. As complexity increases, so does the likelihood of missed doses, incorrect administration, or complete discontinuation.
Patients may struggle to remember when to take each medication, how to coordinate doses throughout the day, or which medications are still necessary. This confusion can be particularly challenging for older adults, patients with cognitive impairments, or those without consistent caregiver support. Regimen complexity is a significant yet often underestimated barrier to medication adherence, and it highlights the importance of simplification and clear education whenever possible.
Side effects are another major contributor to nonadherence. Even when medications are clinically appropriate, patients may discontinue therapy if side effects interfere with daily life. Fatigue, gastrointestinal discomfort, dizziness, or mood changes can be discouraging, particularly when patients are unsure whether these symptoms are temporary or avoidable. In addition to fear of experiencing their own side effects, patients may resist taking their medication if they have witnessed a family member or friend experience side effects from the same or similar medication.
In many cases, fear of side effects prevents patients from fully engaging with treatment at all. Concerns based on prior experiences, medication reviews, or information found online can shape patient behavior long before the first dose is taken. When these fears aren’t addressed through proactive counseling, they become powerful barriers to medication adherence.
Health literacy is the ability to access and understand health information and services that promote and maintain strong health and well-being. When a patient has limited health literacy, it can significantly affect their ability to understand and follow medication instructions. Patients may misunderstand dosing directions, confuse medications with similar names or appearances, or fail to grasp the long-term importance of therapy.
This barrier is often compounded by language differences or overly technical explanations. When patients don’t fully understand why they are taking a medication or how it supports their health goals, adherence becomes fragile. Improving health literacy through clear, personalized education is essential to reducing barriers to medication adherence and empowering patients to take an active role in their care.
For many chronic conditions, the benefits of medication are not immediately felt. Patients managing conditions such as hypertension or high cholesterol may feel physically well, leading them to question the necessity of ongoing therapy. Without symptoms to reinforce the importance of adherence, motivation can decline over time.
This lack of perceived benefit creates a disconnect between clinical intent and patient experience. When patients don’t understand how a medication prevents future complications, adherence may feel optional rather than a life-changing therapy. Addressing this barrier requires consistent reinforcement of long-term goals and outcomes, framed in ways that resonate with the patient’s priorities.
Medication adherence is influenced by behavioral and psychosocial factors that extend beyond the clinical setting. Mental health conditions such as depression or anxiety can reduce motivation and consistency, making it difficult for patients to maintain daily routines.
Social determinants of health (SDOH), including transportation challenges, unstable housing, food insecurity, or limited social support, can further complicate medication access and management. These realities often remain unspoken during routine appointments, yet they represent some of the most significant barriers to medication adherence.
When barriers to medication adherence are left unaddressed, the consequences can be severe. Poor adherence contributes to disease progression, avoidable hospitalizations, and increased healthcare utilization. For patients, this can mean worsening symptoms, reduced quality of life, and frustration with a system that feels disconnected from their needs.
For health plans and providers, nonadherence undermines clinical outcomes, inflates costs, and complicates efforts to improve population health. Addressing adherence needs to focus more than just on improving metrics. The central focus should be on preventing harm and supporting sustainable care.
Pharmacists play a vital role in identifying and overcoming barriers to medication adherence. Through comprehensive medication reviews and patient-centered conversations, pharmacists can uncover challenges that may not surface during brief clinical visits.
By building trust, assessing understanding, and tailoring education to individual needs, pharmacists help bridge the gap between prescribing and real-world use. Their accessibility and expertise make them the ideal health professional to support adherence and improve outcomes across diverse patient populations.
Barriers to medication adherence are complex, interconnected, and deeply human. Addressing them requires the perfect blend of empathy, communication, and a commitment to understanding the patient experience beyond a prescription label.
As healthcare continues to evolve toward value-based models, improving medication adherence will remain a critical priority. By recognizing and addressing the barriers patients face, healthcare organizations can drive better outcomes, reduce unnecessary costs, and deliver care that truly meets patients where they are.
To learn more about the ways Aspen RxHealth can help healthcare teams and organizations improve patient adherence, contact us today.