125,000 deaths.
Every year. Preventable.

The scale of the problem

Every year in the United States, an estimated 125,000 people die from causes directly related to not taking their prescribed medications. That is more than the annual death toll from car accidents, gun violence, or opioid overdoses, yet it receives a fraction of the attention.

The New England Healthcare Institute estimates that medication non-adherence costs the US healthcare system between $100 billion and $300 billion annually in avoidable hospitalizations, emergency room visits, and complications that could have been prevented with a daily pill.

Who is most affected

Non-adherence is not evenly distributed. Some populations face dramatically higher risk:

• Chronic disease patients: An estimated 50% of patients with chronic conditions such as hypertension, diabetes, heart disease, and asthma do not take their medications as prescribed, according to the World Health Organization.
• Elderly adults: Adults over 65 take an average of 5 or more medications daily. Managing complex regimens without support systems leads to significantly higher rates of missed doses and errors.
• Patients without caregiver support: People who live alone or lack family involvement in their health have non-adherence rates nearly double those with active caregiver support.
• Patients with cognitive decline: Memory impairment from Alzheimer's, dementia, or mild cognitive impairment makes medication management nearly impossible without external systems.
• Low-income populations: Cost is a primary driver of non-adherence, but forgetting or not understanding regimens accounts for a significant portion even when medications are affordable.

Why people don't take their medications

Understanding the causes of non-adherence is essential to addressing it. Research consistently identifies five primary reasons:

• Forgetting (most common): Patients simply forget, especially with complex regimens or multiple daily doses
• Side effects: Patients stop medications due to side effects, often without telling their doctor
• Cost: Patients skip doses or split pills to stretch a prescription
• Feeling better: Patients stop when symptoms improve, believing they no longer need the medication
• Complexity: Multiple medications, different timing windows, food interactions, and confusing instructions lead to errors and abandonment

The economic cost

The $300 billion figure from the New England Healthcare Institute represents direct healthcare costs: hospitalizations, ER visits, and additional treatments required when medication non-adherence causes a condition to worsen. This does not include indirect costs such as lost productivity, caregiver burden, or long-term disability.

For context, $300 billion per year is more than the entire annual budget of the US Department of Education, the Department of Energy, and the Department of Housing and Urban Development combined.

More specifically, research published in the American Journal of Health-System Pharmacy found that non-adherence accounts for:

• 33% to 69% of all medication-related hospital admissions
• 23% of all nursing home admissions
• Approximately 10% of all hospitalizations

Hypertension: the silent epidemic of non-adherence

Hypertension (high blood pressure) provides one of the clearest examples of how non-adherence translates into preventable harm. Roughly 70 million Americans have hypertension, and antihypertensive medications are among the most commonly prescribed drugs in the world. Yet studies consistently show that fewer than 50% of hypertension patients take their medications consistently after the first year.

The consequences are stark: uncontrolled hypertension is the leading modifiable risk factor for stroke, heart attack, and kidney disease. Each of these conditions costs tens of thousands of dollars to treat and dramatically reduces quality of life.

Diabetes: the adherence gap that causes complications

For patients with Type 2 diabetes, medication adherence directly correlates with blood sugar control, which determines long-term outcomes. Studies show that diabetic patients who are adherent to their regimen have an HbA1c that is 0.5% to 2% lower than non-adherent patients. That difference, sustained over years, is the difference between normal kidney function and dialysis. Between clear vision and blindness. Between walking and amputation.

Yet adherence rates among diabetes patients average only 67% to 85%, meaning a significant portion of all diabetic patients are consistently under-medicating even when they can afford their prescriptions.

What actually improves adherence

Decades of research have identified several interventions that reliably improve medication adherence:

• Reminders: Text, app, or alarm-based reminders reduce missed doses by 20% to 50% in most studies
• Family involvement: Patients whose family members are aware of their regimen and ask about it are significantly more adherent than those managing alone
• Simplified regimens: Once-daily dosing has dramatically higher adherence rates than multiple-daily dosing
• Doctor communication: Patients who believe their doctor will review their adherence are more likely to take their medications
• Accountability systems: Any mechanism that creates a record of whether a dose was taken improves adherence

The opportunity

Medication non-adherence is not a hopeless problem. The interventions that work are known, they are not expensive, and they do not require major changes to how healthcare is delivered. What they require is a system that patients will actually use daily, that keeps families informed, and that gives physicians actionable data.

That is what Eva is built to be.