<p>Routinized pill-taking can enhance medication adherence but is difficult to achieve. In this pilot randomized controlled trial we assess the feasibility, acceptability, and preliminary efficacy of a novel behavioral economics-based approach to medication-adherence. We enrolled 60 hypertensive adults, who all received information on pill-routinization and selected an existing behavioral routine (‘anchor’) to assist with routinization of pill-taking. Participants were randomized into 3 groups: 1)‘Control’ receiving usual care (<i>n</i> = 20); 2)‘Messages’ receiving daily text messages (<i>n</i> = 20); and 3)‘Incentives’ receiving both text messages and rewards for medication adherence (<i>n</i> = 20). Interventions lasted 3 months, followed by a 6-month post-intervention period during which we assessed medication-adherence and conducted standardized assessments of acceptability. The study demonstrated high feasibility and acceptability, with 90% of participants willing to refer others to the study. Mean adherence during the extended follow-up period (months 7–9) was numerically higher in both intervention arms than the control arm (Control 75%, Messages 84%, and Incentives 77%) though this pilot study was not powered to detect a statistically significant difference (<i>P</i> = 0.73). While this pilot study was under-powered to detect between-group differences, the novel behavioral economics habit formation approach was feasible, acceptable, and yielded promising results, warranting completion of a fully-powered trial. </p><p>Registration: URL:&#xa0;<a href="https://www.clinicaltrials.gov">https://www.clinicaltrials.gov</a>; Unique identifier: NCT04029883; registered 23/07/2019.</p>