CDC Report: 9 Million Americans Not Taking Medications as Prescribed Due to Cost

A new report from the Centers for Disease Control and Prevention (CDC) cited the high cost of prescription drugs to cause more than 9 million adults to not take their medications as instructed.

Prescription drugs can be expensive, especially in the U.S. In fact, research shows that Americans spend more on prescription drugs per capita than people in any other country—or about $1,200 more per person. And these high costs are not without consequences.

The high cost of prescription drugs has caused more than 9 million adults between the ages of 18 and 64 to skip doses, take smaller amounts, or delay refills, according to a recently released report by the CDC. That number represents 8.2% of adults in 2021 who did not take the prescriptions they needed.

According to the CDC, women were most likely to skip or delay taking prescribed drugs. Those with disabilities were also impacted by rising drug costs, with 20% taking measures to ration their medications because of cost. And, people in poor health and those without health insurance also did not take their medications as prescribed due to the associated expense.

“Even when they are covered by their insurance, American patients who struggle to afford the cost of prescription drugs often choose not to take them,” Laura Purdy, MD, MBA, board-certified family medicine physician told Health.

“Many people are hesitant to take chronic disease-treating medications, such as those for diabetes, hypertension, or high cholesterol simply because of cost,” she said. “But, this dilemma can lead to a worsening health condition, hospitalization, or even death.”

Prescription Drug Prices in the U.S.

A recent RAND Corporation study found that U.S. drug prices were 2.56 times higher than those in 32 comparable countries, with brand-name drug prices averaging 3.44 times higher. What's more, researchers note that across all of the Organization for Economic Co-operation and Development (OECD) nations studied, total drug spending was $795 billion, with the U.S. accounting for more than half of the sales or 58%, but just 24% of the volume.

“Branded medications are typically the most common for patients to stop taking,” explained Deepti Pidakala, PharmD, a pharmacist with Marley Drug, a full-service pharmacy that offers home delivery nationwide.

“They are expensive, require prior authorizations from insurance, and often are not covered at all,” she said. “This waiting period back and forth with insurance, along with the financial strain, causes many patients to stop taking their medications altogether.”

A Kaiser Family Foundation Health Tracking Poll found that eight in 10 adults said the cost of prescribed medications in the U.S. was unreasonable. Affordability is particularly an issue for those taking four or more prescription medicines. Researchers found that three in 10 of those taking four or more drugs have trouble affording their prescriptions, compared to one in five adults who currently take three or fewer prescription medications.

Affordability issues are likely to continue to worsen, especially since prescription drug prices have been on an upward trajectory. Drug spending in the U.S. increased by 76% between 2000 and 2017. These costs are expected to rise faster over the next decade than other areas of healthcare spending.

Risks Associated With Skipping Medication Doses

John Villanova, RPh, a pharmacist with Marley Drug, warned that skipping medication can have catastrophic results. “We know that prior authorizations and non-medical switching are hurting patients,” he said. “The same can be said for patients not taking their medications due to cost.”

Medications are meant to help people. But if they are not being taken as prescribed because people are rationing them, cutting pills in half, or skipping doses, then this can lead to poor patient outcomes. In the long run, it also can add costs to the healthcare system, Villanova noted.

“Suppose someone with heart failure taking diuretic stops taking their medication; they could end up in the hospital with trouble breathing because their lungs are filling with fluid,” he explained. “Just go visit an ER or a long-term care facility, and you’ll see what I mean. This is happening every day.”

The Role of Health Insurance

Health insurance also plays a significant role in rising drug costs, added Rima Arora, PharmD, a pharmacist, and director of pharmacy at DiRx.

Health insurance companies have internal parameters to determine which medications will be covered or the tiers for coverage, under their formularies—all of which can lead to increased costs for the consumer. Sometimes even generic drugs are on their exclusion lists or have been adjusted to a higher tier costing the consumer more, she explained.

“We’ve reached a point now where out-of-pocket healthcare costs do not make sense,” agreed Neil Owens, PhD, the president and COO of Medicure. “Patients are often paying more with their co-pay than the actual medication costs.”

People then stop taking their medications or try to ration them because of the constant changes in their coverage and cost, he explained. “One month their medication is covered and the next it isn’t, or there are new requirements to meet. That makes people give up.”

Reducing Prescription Drug Costs

If you are finding that your medications are no longer affordable, you may want to speak with a pharmacist or the drug provider to see if there are less expensive options available, suggested Susan Lang, CEO and founder of Visory Health. “You can also ask your pharmacist for help in identifying cost-effective options so you can stay on your medication and stay healthy.”

Another option might be a drug assistance program that offers free or low-cost medicines if you don’t have insurance or cannot afford your medicine. You could also research co-pay assistance programs, generic drug options, and discount pharmacy cards like those offered by GoodRx and Visory Health.

Another option is to look into pharmacies that allow you the option to self-pay for your prescriptions instead of using your insurance like Marley Drug, Freedom Pharmacy, DiRx, and more. These types of pharmacies allow you to get your prescription at a cost that is significantly less than a traditional pharmacy might charge.

For instance, Abiraterone, which is used to treat prostate cancer costs $20,309 cash for 120 tablets from a national pharmacy chain and $2,835 with a GoodRx coupon, Villanova explained. Marley Drug’s price is $152 for 120 tablets, he noted.

“By sourcing directly from manufacturers, pharmacies can bypass the system intermediaries such as drug wholesalers and PBMs (pharmacy benefit managers) to lower prices for consumers,” added Arora. “Online pharmacies are also offering programs where a preset number of prescriptions and unlimited refills are provided for an entire year to consumers for a very low annual fee.”

Keep in mind that when using traditional pharmacies, the price will be the same no matter where you go when you fill through insurance, emphasized Pidakala. “Americans don’t realize that you can forgo your insurance and pay cash.”

Because the self-pay price at these pharmacies may vary widely in the U.S., it is important to do your research, though. It’s also important to note that even though these pharmacies are cash-based, they still may accept your HSA credit card or other payment cards. Also, some may be state-specific and others may be able to offer prescriptions regardless of where you live.

Overall, if you are overwhelmed with your drug costs, Dr. Purdy suggested starting by opening a discussion with your healthcare provider. “Find out about other treatment options, less expensive generics, or patient-assistance programs provided by non-profit or pharmaceutical organizations. You also can speak to local lawmakers to make prescription drug affordability a top priority.”