In 2023, Canadian researchers tracked what happened when doctors prescribed new medications to 34,000 primary care patients. One in six never filled the prescription. Among those who did, studies consistently show that roughly half the number of patients stop taking their medication within a year.
For patients, this means poorer outcomes. For pharmaceutical companies, it means something equally significant: weaker real-world evidence, reduced payer confidence, and diminished commercial impact.
Non-adherence isn’t just a clinical problem. It’s a strategic one.
Yet pharma’s digital solutions often treat it as a memory issue, meaning more notifications, more prompts, and more nudges. "Take your pill. Log your symptoms. Check in today.” These mechanics can boost short-term engagement metrics, but rarely move the needle on the ultimate outcome that matters: sustained treatment adherence and persistence.
Non-adherence can absolutely stem from forgetfulness. But more often, it reflects hesitation, mistrust, uncertainty about benefits, or competing life demands. In a moment where public trust in pharma is under pressure (particularly in the US), approaches that rely primarily on gamified compliance struggle to address the deeper barriers that shape real-world behaviour.
A trust problem gamification alone can't solve
Gamified reminders may help with consistency, but it can’t overcome an empathy or trust gap. It’s all too easy to disengage from treatment when you don’t fully understand or trust it. Patients have to understand how medication fits into their daily lives.
Compliance means doing what you're told. Adherence means understanding why it matters to your specific life. Most pharma apps are designed for compliance metrics. Very few are designed for sustained adherence. Research shows that extrinsic motivation – the drive to do something because of external rewards or avoiding punishment, rather than for internal satisfaction – fails long-term. Once novelty wears off, the behavior disappears, and the benefits are lost.
When every app on a device uses the same nudging technique – finance, banking, entertainment, fitness – users become overwhelmed. They become numb to nudges.
Motivation design in pharmaceuticals must sit within a broader ecosystem of treatment that is bolstered by communication, access, and consistency of care. Reminders won’t address why someone might choose to stop. Cost concerns. Side effects. Lack of understanding about long-term benefits versus short-term discomfort. These aren't memory failures. They're decision points no notification can resolve.
What intrinsic motivation looks like
Studies on motivational interviewing demonstrate that intrinsic motivation – an internal drive rooted in personal meaning – leads to substantially better long-term adherence.
Through ustwo's work with pharmaceutical clients, we've seen what works when reminders fail. One diabetes management platform delivered "just in time" information rather than "all the time" notifications. The approach: spend the first week building a baseline. Help people understand their own rhythms and barriers before pushing behavior change. This approach improved engagement, whilst also creating conditions for sustained behaviour change by aligning intervention timing with patient readiness.
For a migraine tracking app, contextual design meant recognizing an obvious truth: when you've got a screaming headache, you don't want heavy screen interaction. The solution was one-tap recording via watch, a quick swipe to indicate intensity, then deeper detail entry hours later when symptoms subside.
The challenge for pharma is to build patient-centred experience ecosystems that strengthen confidence, reduce friction, and create the intrinsic motivation that sustains long-term treatment behaviour.
The best products don’t rely on repeating the same prompt indefinitely. They evolve with the patient, introduce new layers of support over time, and create shared visibility between patient and clinician. When over 60% of US adults struggle with health literacy, shifting behaviour from prescriptive “take this now”, to participatory “here’s how this fits into your life”, is vital.
The commercial impact is direct. Better adherence leads to stronger real-world evidence, clearer demonstration of value to payers, improved formulary positioning, and ultimately longer persistence on therapy.
If your app needs constant notifications, it’s prompting action and not behaviour change. When you design for intrinsic motivation, you support better outcomes for patients and stronger outcomes for the business.
That’s the difference between compliance and genuine care. That’s the difference between digital tools that chase engagement and those that drive measurable value.
Read more on our work in healthcare.