Financial Incentives Boost Medication Adherence But Fail to Improve Blood Pressure Outcomes in NYC Study

The Behavioral Economics Trial To Enhance Regulation of Blood Pressure (BETTER-BP) study, involving 400 adults receiving care at three New York City community health clinics, revealed that financial incentives successfully changed medication-taking behavior during the intervention period but failed to produce lasting health benefits. Presented at the American Heart Association's Scientific Sessions 2025 and published in the peer-reviewed journal JACC, the research focused primarily on Medicaid recipients and uninsured individuals who often struggle with medication adherence, highlighting the challenges of managing chronic conditions in populations facing socioeconomic barriers to consistent healthcare.

During the six-month rewards period, participants randomly assigned to the incentives group were twice as likely to take their blood pressure medication, with 71% consistently opening their medication bottles compared to only 34% in the control group without incentives. Researchers used electronic pill bottles to monitor medication bottle openings as a measure of daily medication use, rather than relying on self-reported data. However, both groups experienced similar systolic blood pressure reductions—6.7 mm Hg in the rewards group versus 5.8 mm Hg in the control group—and when cash rewards ended after six months, participants in the incentives group reverted to their previous patterns of inconsistent medication use.

"Financial incentives clearly worked to change behavior during the study period because people in the rewards group took their medication much more consistently. However, we were surprised that the behavior change didn't translate to significantly better blood pressure control," said Dr. John Dodson, principal investigator of the study and associate professor at NYU Grossman School of Medicine. The findings suggest that improving medication adherence involves more complex factors than previously understood, particularly for achieving long-term behavior changes in chronic disease management.

The study population represented a diverse group with a median age of 57 years, 60.5% women, and significant representation of Hispanic (61.5%) and Black (20.3%) individuals. More than 70% were covered by Medicaid or had no health insurance, and many had additional health conditions including obesity (54.5%) and Type 2 diabetes (46.5%). These demographic characteristics underscore the importance of developing effective interventions for populations that face multiple barriers to consistent healthcare access and medication adherence.

Researchers noted several limitations to the study, including that electronic pill bottles only monitored whether bottles were opened, not whether medication was actually taken. Additionally, researchers monitored only one blood pressure medication per participant, though many were prescribed multiple medications. The study used standardized office blood pressure measurements rather than more frequent home monitoring, which might have yielded different results. More information about high blood pressure management is available at https://www.heart.org/en/health-topics/high-blood-pressure.

The implications of this research extend beyond hypertension management to broader questions about how to effectively support long-term medication adherence in vulnerable populations. While financial incentives show promise for short-term behavior modification, the study suggests they may not address underlying barriers to consistent medication use or translate to improved health outcomes. This has significant implications for healthcare providers, policymakers, and insurers seeking cost-effective interventions for chronic disease management, particularly in safety-net healthcare settings serving economically disadvantaged communities.