Medication adherence, the extent to which patients take medications as prescribed, is the most effective way for patients to improve their health, especially when it comes to chronic diseases like diabetes, heart disease, hypertension, and more. When patients are adherent, they will find improvements in their overall health, lowered healthcare costs, and improved patient satisfaction. Yet, despite its clinical importance, adherence remains one of healthcare’s most persistent and costly challenges.
According to The American Heart Association, it is estimated that over half of the medications prescribed to patients with chronic diseases are not taken as directed. When adherence fails, the consequences create a ripple effect across the entire healthcare system such as worsening conditions, avoidable hospital readmissions, lower HEDIS and STAR ratings, increased emergency visits, and higher total cost of care.
Medication non-adherence stems from a range of behavioral, financial, and logistical barriers. While that may seem daunting, pharmacists are uniquely positioned to address these barriers through proactive, personalized interventions, driving measurable improvements for patients, providers, and health plans alike.
The scope of the medication adherence problem
Despite widespread awareness, adherence remains a persistent challenge. As previously mentioned, more than half of patients with chronic diseases don’t take their medications as prescribed. For instance, studies by the Centers for Disease Control & Prevention (CDC) show that 20–30% of prescriptions are never filled for patients with diabetes. These are scary statistics for patients and lead to bad numbers for healthcare plans, ultimately impacting CMS quality measures.
Non-adherence is more than a missed dose; it creates a widespread health and economic burden. Poor adherence claims the lives of a staggering 125,000 Americans on an annual basis. This has cost the healthcare system as much as $300 billion a year in additional medical appointments, emergency department visits, and hospitalizations.
The downstream impact is significant; these long-term complications strain both patients and the healthcare system. For health plans, non-adherence can lead to lower HEDIS (Healthcare Effectiveness Data and Information Set) scores, as well as reduced STAR ratings, reduced CAHPS (Consumer Assessment of Healthcare Providers & Systems) scores, and poor member satisfaction, all of which directly influence reimbursement and performance metrics.
Keep in mind that chronic conditions like diabetes, hypertension, and cardiovascular disease are among the most impacted, and these conditions are among the top causes of death in the U.S.. This emphasizes the critical need for medication adherence to be a key factor in health management strategies for a sweeping amount of patients. However, it doesn’t come without challenges.
Understanding the top three barriers to medication adherence
Adherence challenges rarely stem from a singular cause. Instead, they emerge from a complex combination of behavioral, financial, and logistical factors. Understanding these barriers is critical to develop tailored medication adherence strategies for patients.
1. Behavioral barriers
Behavioral barriers significantly affect a patient’s ability to take medications as prescribed. These challenges often stem from everyday habits, mental health, and perceptions about their treatment, which can lead to inconsistent or missed doses. Common examples include:
- Forgetfulness or inconsistent routines.
- Misunderstanding prescription instructions.
- Lack of perceived need, especially for asymptomatic conditions.
- Mental health challenges, including depression and anxiety.
- Busy lifestyles, where health management takes a backseat.
Health literacy and cultural influences can also play a major role in how patients perceive and use medications. These factors can shape their understanding of treatment importance, influence their trust in healthcare providers, and their willingness to follow prescribed regimens. These factors can either support or hinder adherence, depending on how well educational resources and approaches to care align with patients’ backgrounds and beliefs.
2. Financial barriers
Even when patients are motivated to follow their treatment plans, the cost of medications can be a major roadblock. Financial constraints remain one of the most common and preventable reasons patients don’t take their medications as prescribed. These challenges can take many forms, including:
- High copays or tiered pricing discourage patients from filling prescriptions.
- Lack of insurance or inadequate coverage.
- Cost-related medication rationing, where patients skip doses or split pills.
Pharmacists can help by identifying alternatives, recommending generic options, and guiding patients through copay assistance programs.
3. Logistical barriers
Adherence isn’t just about willingness; it is also about access, convenience, and clarity. Even the most well-intentioned patients can struggle with staying on track when faced with real-world obstacles in their daily routines. These challenges often go unnoticed but have a major impact on medication adherence in several ways, including:
- Pharmacy deserts and transportation affecting access.
- Pharmacy closures accelerating in rural and underserved areas.
- Complex regimens with multiple medications overwhelming patients.
- Language or health literacy barriers impeding understanding and trust.
Four medication adherence strategies for pharmacists
Pharmacists are one of the most accessible and trusted healthcare providers. Positioned at the center of care and community, they are well-equipped to tackle adherence barriers from all sides.
At Aspen RxHealth specifically, our community of pharmacists provides tailored support based on language, location, and clinical expertise. These highly tailored consultations build trust, improve satisfaction, and empower patients to stay on course.
Pharmacists can implement several impactful strategies, particularly when supported by technology platforms to best improve a patient’s adherence.
1. Medication therapy management (MTM)
Medication therapy management (MTM) allows pharmacists to conduct comprehensive reviews of a patient’s medication regimen, identifying gaps in care, inappropriate therapies, or drug interactions. In doing so, they can make recommendations or adjustments to treatment plans accordingly and ensure patients are receiving the right care for their conditions.
2. Education and empowerment
Through one-on-one counseling, pharmacists can correct misconceptions, improve understanding, and build confidence. Cultural sensitivity is crucial, matching language, location, and communication style to the patient’s needs can dramatically increase adherence.
By taking these factors into consideration, pharmacists can tailor their patient education strategies to be more effective for patients. For example, for patients who may not understand complex medical jargon, informational visuals or videos may be a better method to explain topics. And, when patients understand the importance of adherence and how to maintain a consistent treatment schedule, they’re more likely to remain engaged and see positive outcomes.
3. Simplification and support
Pharmacists help streamline care by:
- Aligning refill dates
- Reducing regimen complexity
- Providing reminders and alerts
- Navigating financial assistance or insurance processes
Further, pharmacists can work with care teams to understand medication reconciliation needs or challenges that the patient may have faced previously, also positioning the pharmacist to provide more personalized support.
4. Telepharmacy & remote consultations for accessibility
Telepharmacy reduces barriers for patients in remote or underserved communities. Being able to speak to a patient over the phone eliminates logistical barriers such as pharmacy deserts and closings. Our BeWell with Aspen RxHealth platform allows pharmacists to reach patients wherever they are, breaking down geographic and timing constraints.
With a nationwide network of multilingual pharmacists, Aspen RxHealth’s software solutions bring clinical expertise directly to the patient: no waiting rooms or travel required.
Health plan and system-level support for medication adherence
Health plans play a pivotal role in medication adherence by investing in scalable, pharmacist-driven models of care including our Alliance by Aspen RxHealth solution.
Alliance gives health plans the flexibility to:
- Utilize their own in-house teams.
- Tap into Aspen RxHealth’s network of pharmacists.
- Deliver culturally competent, patient-centered care at scale.
- The ROI of medication adherence
These programs drive meaningful improvements in HEDIS, STAR ratings, and CAHPS, while supporting value-based care initiatives.
Pharmacist-led programs also reduce the total cost of care through fewer emergency visits, hospitalizations, and disease complications, making the return on investment clear.
Improving the pharmacy system through medication adherence strategies
Medication adherence is a shared challenge, but it also presents a shared opportunity. By addressing the behavioral, financial, and logistical barriers that patients face, pharmacists can reshape the adherence landscape.
Health plans that invest in scalable, pharmacist-led solutions like Alliance, are better equipped to achieve clinical, operational, and financial goals.
Looking to improve adherence, satisfaction, and outcomes for your member population Contact Aspen RxHealth to request a demo and learn how our nationwide pharmacist network and the Alliance platform can support your goals, whether through in-house teams or scalable, outsourced support.
Together, we can make adherence achievable.
