13 Million Americans Per Year Skip Medicine Due to High Prescription Cost

drug costs

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Key Takeaways

  • 13 million Americans skipped their prescribed medicine in the year before the pandemic because of high costs, a new study found.
  • President Joe Biden's Build Back Better Act aims to limit annual drug price increases in Medicare and private insurance.
  • The new bill would also cap the out-of-pocket costs at $2,000 for Medicare patients.

When people are unable to afford prescription medications, they may delay or skip their medication, which can be consequential to their health. A recent survey by the Urban Institute found that from 2018 to 2019, almost 13 million Americans delayed or didn’t get their prescription drugs because of financial barriers.

Researchers said it shed light on the need to reduce the price of prescription drugs, limit out of pocket costs, and expand health coverage. 

“The ability to afford prescription drugs can have very significant consequences for a person's health,” Michael Karpman, lead researcher of the study, told Verywell. “There have been other studies showing that when patients are not able to get their medications or don't adhere to the medications that they're prescribed, that can lead to worse health problems and more expensive treatments down the road.”

Karpman said that the study was prompted by current government efforts to lower prescription costs and the pending provisions under the Build Back Better Act, which seeks to close insurance coverage gaps and limit drug price increases. His team was specifically interested in how many people who used Medicare or commercial insurance encountered financial barriers to prescriptions, as they could be the most affected by reforms discussed in Congress.

A Kaiser Family Foundation (KFF) poll on prescription drug prices found that three in 10 U.S. adults have cut pills in half, skipped a dose, or taken an over-the-counter drug instead because of the cost for prescription medications. Around 83% of the respondents said that prescription drug prices were unreasonable, even though a majority also said they did not struggle to afford their drugs.

KFF polls, like the Urban Institute study, are conducted in anticipation of government decisions to gauge public opinions on health policy issues. In another 2019 poll, KFF found that the majority of adults were in favor of reducing prescription drug costs. 

Lunna Lopes, a researcher with the KFF, told Verywell that even if the general public can afford their medications, their feelings about the prescription costs are a projection of how unreasonable the prices may be for people with lower incomes.

According to the Urban Institute study, almost 5% of Medicare beneficiaries—nearly 2.3 million older adults—had unmet prescription needs prior to the pandemic. Just shy of 3% of Medicare beneficiaries, or about 1.3 million people, reported spending more than $2,000 out-of-pocket, which would be the new cap in a provision under the Build Back Better Act that was recently passed by the House of Representatives.

For uninsured individuals, 9.5% reported unmet prescription drug needs. People with private insurance were not spared from high costs either: about 20% of adults with private insurance paid $500 out-of-pocket on prescription drugs, and 9% of them spent over $1,000.

Factors like race, sex, financial status, and health conditions also affected one’s ability to afford prescriptions. Women, older adults, people living in underserved communities were more likely to have an unmet prescription need, according to the study. But Karpman said the study did not examine these associations.

Lopes added that women are more likely to not take their medicine as prescribed because of the high costs. Black Americans and people with chronic health conditions are also more likely to report difficulties in affording medication.

“It's an issue that obviously impacts certain groups of people more than others,” Lopes said. “There are a chunk of Americans who do have to face these kinds of [consequences] in terms of not filling or not taking their medications as prescribed because of cost.”

What This Means For You

A poll found that the majority of people in the United States think that prescription drugs are unreasonably priced, even if they themselves can afford them. Research shows that people who can’t afford prescription drugs face barriers to treatment, which could impact their health.

1 Source
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  1. Robert Wood Johnson Foundation. In the Years Before the COVID-19 Pandemic, Nearly 13 Million Adults Delayed or Did Not Get Needed Prescription Drugs Because of Costs.

By Claire Wolters
Claire Wolters is a Philly-based reporter covering health news for Verywell. She is most passionate about stories that cover real issues and spark change.