The High Cost of Missed Medications

How Rx Adherence Engagements Keep Members on Track

Let’s say a member with heart disease picks up their high-cost prescription, takes it for a few weeks, and then stops. Maybe they feel better. Maybe the side effects are frustrating. Maybe they just forgot.

The result? Their condition worsens. They end up in the ER. A hospital stay follows. Costs skyrocket.Multiply this by thousands of members, and payers are left potentially covering millions in avoidable claims.

This isn’t just a personal health issue – it’s an industry-wide crisis. Medication non-adherence costs the healthcare system an estimated $528 billion annually in preventable hospitalizations, complications, and additional treatments.

And yet, traditional outreach still relies on basic refill reminders, expecting members to stay on track on their own. But if a reminder was enough, adherence wouldn’t be a problem. So, what’s missing?

Members Aren’t Taking Their Medication

Medication adherence isn’t as simple as forgetting to refill a prescription. The reasons members don’t take their meds go deeper:

• Cost Barriers: High out-of-pocket expenses make skipping doses seem like a reasonable option.
• Side Effects: Members may stop taking meds due to discomfort without discussing alternatives with their provider.
• Complexity: Some prescriptions require multiple doses, specific timing, or lifestyle changes that members struggle to maintain.
• Lack of Perceived Urgency: If they feel fine, they assume they don’t need it until their condition spirals.

Traditional engagement treats every member the same, but the truth is, adherence gaps are personal. To solve them, we need a more targeted, data-driven approach.

A Smarter Rx Adherence Strategy

The solution isn’t just sending more messages… it’s sending the right messages at the right time, with the right intervention.

Rx Adherence Engagements use AI-driven automation to:

• Predict non-adherence before it happens by analyzing behavioral patterns and prescription data
• Engage members with personalized outreach tailored to their specific barriers – cost, side effects, or complexity
• Provide actionable support like lower-cost alternatives, pharmacy coordination, or provider discussions
• Track adherence in real time and refine outreach strategies based on response rates

This isn’t a static engagement – it’s a dynamic, intelligent system that continuously adapts to member behaviors.

Clarity Performance Solutions: Turning Data into Actionable Engagement

At Clarity Performance Solutions, we go beyond simple refill reminders. Our Rx Adherence Engagements feature uses predictive analytics and personalized automation to ensure members don’t just pick up their prescriptions – they actually take them. By analyzing behavioral patterns, claims data, and prescription histories, our member engagement platform identifies members at risk of non-adherence before it becomes a problem. Instead of generic outreach, members receive targeted, multi-channel engagement that speaks to their specific barriers, whether it’s cost concerns, side effects, or confusion about their medication regimen.

This approach ensures that engagement isn’t just reactive, but proactive, guiding members toward better medication habits with the right intervention at the right time. By integrating real-time adherence tracking with pharmacy and claims data, Clarity helps payers reduce avoidable hospitalizations, improve medication compliance, and ultimately lower overall healthcare costs.

If your engagement strategy isn’t improving adherence and reducing unnecessary costs, it’s time for a new solution. Let’s talk about how Clarity can help.