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Pricey Pills: The Impact of Soaring Medication Costs on Patient Adherence

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A report from the National Center for Health Statistics (NCHS) reveals a concerning trend: approximately 8% of adult Americans are not taking their medications as prescribed because they cannot afford them. This issue is exacerbated by insurance coverage disparities, with individuals on Medicaid or without insurance being more likely to skip medications due to cost.

The Burden of High Medication Costs on Low-Income Populations

The NCHS survey, conducted by researchers Robin A. Cohen and Maria A. Villarroel, highlights the financial strain on the most vulnerable members of society. Among adults under the age of 65, those with private insurance were less likely (6%) to skip medications to save money, compared to 10% of those on Medicaid and 14% of those without insurance. The situation is even more dire for the poorest adults, with nearly 14% forgoing their prescribed medications to save money.

To alleviate this burden, some individuals resort to alternative strategies such as asking doctors for lower-cost medications, purchasing prescription drugs from other countries, or seeking alternative therapies.

The Consequences of Not Taking Medications as Prescribed

Managing multiple medications is already a challenging task, but not taking them as prescribed can have severe consequences. The repercussions can range from unnecessary complications related to a medical condition, increased risk of heart attack or stroke, and higher medical costs due to hospitalization or additional medical interventions.

The soaring prices of prescription drugs make it challenging for many Americans to fill their prescriptions or take them as directed, even with health insurance that includes prescription drug benefits. Copayments alone can be prohibitively expensive, and the continuous introduction of new medications further complicates matters.

Strategies for Cutting Medication Costs Safely

If you are struggling to afford your medications, consider discussing the following questions with your doctor:

  • Which medications are most essential for me? Your primary care physician can help you determine the necessity of each drug in your regimen, explaining how it improves your quality of life, keeps you out of the hospital, or prolongs your life.
  • Which medications can I stop with minimal risk to my health? This question may require personal research and a shared decision-making process with your doctor.
  • Are there lifestyle changes I can make to reduce my reliance on medications? For conditions like high blood pressure and type 2 diabetes, lifestyle changes, such as increased exercise and a healthier diet, can often decrease the number of medications and their dosages.

Additional cost-saving tips:

  • Request "preferred" medications from your doctor if you have a prescription drug plan, as these tend to be the least expensive.
  • Inquire about generic versions of your medications with your doctor or pharmacist.
  • If no generic is available, ask if a less-expensive brand name drug in the same medication family would work as well.
  • Consider pill splitting if there is little cost difference between low-dose and high-dose versions of your medication. A pill splitter can save you up to 50% on costs.
  • Compare prices among different pharmacies, as prescription medication costs can vary significantly between establishments.

Addressing the Root Causes of High Medication Costs

The rising cost of medications is a multifaceted issue, with numerous contributing factors. Addressing these factors requires systemic changes in the pharmaceutical industry, as well as modifications to healthcare policies and practices. Some potential avenues for change include:

  • Implementing price controls or caps on prescription drugs to prevent excessive pricing.
  • Encouraging and supporting greater transparency in drug pricing, allowing consumers to make informed choices.
  • Expanding access to affordable healthcare coverage, including prescription drug benefits, for uninsured and underinsured individuals.
  • Promoting the development and availability of generic medications, which are generally less expensive than their brand-name counterparts.
  • Facilitating international cooperation and collaboration to regulate drug prices and ensure fair access to essential medications worldwide.

The Role of Healthcare Providers in Mitigating Medication Costs

Healthcare providers play a crucial part in helping patients navigate the complexities of medication costs. By being proactive and engaging in open communication with patients, providers can assist in identifying potential cost-saving solutions. This includes prescribing generic medications, recommending therapeutic alternatives, and providing information about financial assistance programs.

Moreover, healthcare providers can advocate for systemic changes in the pharmaceutical and healthcare industries to make medications more affordable for their patients. By participating in policy discussions, lobbying for reforms, and raising public awareness, healthcare professionals can contribute to addressing the root causes of high medication costs. Unfortunately, change is very slow in the healthcare industry in the United States. This is one of the reasons we called the US healthcare system a pseudosystem.


The high cost of medications is a significant barrier to healthcare access for millions of adults in the United States. As a result, many individuals are forced to skip their prescriptions or seek alternative strategies to save money, often at the expense of their health. Addressing this issue requires a combination of individual and systemic approaches, including changes in the pharmaceutical industry, healthcare policies, and practices. Healthcare providers have a crucial role in helping patients navigate the complexities of medication costs and advocating for systemic changes that promote affordability and accessibility.


  1. Cohen, R. A., & Villarroel, M. A. (2015). Strategies Used by Adults to Reduce Their Prescription Drug Costs. National Center for Health Statistics. Retrieved from
  2. Kesselheim, A. S., Avorn, J., & Sarpatwari, A. (2016). The High Cost of Prescription Drugs in the United States: Origins and Prospects for Reform. JAMA, 316(8), 858-871. doi:10.1001/jama.2016.11237. Retrieved from
  3. Patel, Y. R., & Mehta, D. (2020). Factors Related to High Prescription Drug Costs and Implications for Patients: A Review. Pharmacy and Therapeutics, 45(4), 220-225. Retrieved from
  4. American College of Physicians. (2016). Stemming the Escalating Cost of Prescription Drugs: A Position Paper of the American College of Physicians. Annals of Internal Medicine, 165(1), 50-52. doi:10.7326/M15-2768. Retrieved from
William H. McDaniel, MD

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School.

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