OBJECTIVES: Drug non-adherence is associated with significant negative economic and public health burdens. The objective is to contribute to the literature on negative monetary incentives (i.e., penalties) by developing a discourse for an innovative approach that could be validated in further experimental studies. METHODS: A comprehensive database search (PubMed, EconLit) was conducted on economic incentive programs to enhance adherence in drug therapy. Criteria for evaluation of the retrieved economic studies have been taken from the literature. RESULTS: Little evidence explicitly dealing with economic incentives in the form of monetary sanctions in order to improve adherence or compliance was retrieved from the literature search. Ethics legitimate incentive-based healthcare designs including penalties if elements such as the standard of knowledge, social awareness, and individual responsibility are well addressed and outweigh any profit orientation. Transaction costs remain the main barrier in both institutional implementation and practical enforcement of contractual monitoring and settlement of penalties. Hence, a multifaceted approach would be necessary to present a sustainable concept fulfilling the aspects of equal access to healthcare, social equity, and economic viability. CONCLUSIONS: Financial penalties for drug non-adherence are still a long way off as the concept lacks a simple solution. This paper contributes to the widespread discussion by concentrating and aggregating widely scattered figures of dispute within a coherent argumentative discourse drawing on insights from the field of health economics.