Millions of adults skip medications, primarily due to their high cost

Millions of adults skip medications, primarily due to their high cost

By Howard LeWine, M.D.

Harvard Health Blog

Medications can do wonderful things, from fighting infection to preventing stroke and warding off depression — but they don’t work if you don’t take them. Some people don’t take their medications as prescribed because they forget, or are bothered by side effects.

A new report from the National Center for Health Statistics shines the light on another reason: Some people can’t pay for their medications.

The survey, conducted by NCHS researchers Robin A. Cohen and Maria A. Villarroel, found that about 8 percent of adult Americans don’t take their medicines as prescribed because they can’t afford them. Insurance coverage often influenced this money-saving strategy.

Among younger adults (those under 65), 6 percent who had private insurance skipped medicines to save money, compared to 10 percent for those with Medicaid and 14 percent of those with no insurance. Among the poorest adults — those with incomes well below the federal poverty level — nearly 14 percent did not take medications as prescribed to save money.

Other strategies that those surveyed said they used to save money on drug costs included asking doctors for lower-cost medications, buying prescription drugs from other countries, and using alternative therapies.

The findings were published online as a National Center for Health Statistics Data Brief.


Given the range of health conditions that many adults face, from high cholesterol and high blood pressure to arthritis, diabetes, and more, it’s not unusual for some people to take five or more different prescription drugs per day. Some people I admit to the hospital have 10 or more different medications listed on their medical records. Even if they could afford them, managing that many different medicines is a challenge — and is often impossible.

Not taking medications as prescribed can cause serious problems. It can lead to unnecessary complications related to a medical condition. It can lead to a bad outcome, like a heart attack or stroke. It can also increase medical costs if hospitalization or other medical interventions are needed.

In light of the high price of most prescription drugs, it’s not surprising that many Americans choose not to fill a prescription or take it as directed to save money. Even with health insurance that includes a prescription drug benefit, the copayments alone can be a prohibitive.

New medications continue to be approved yearly; few are taken off the market. The price of new drugs is always high, and prices don’t always fall when drugs become available as generics.


If you’re having difficulty affording your medications, here are some questions to ask your doctor:

1. Which medicines are the most essential for me? If your medications have been prescribed by different doctors, ask one of them — preferably your primary care physician — which ones are really necessary. Get an explanation of how each drug improves your quality of life, keeps you out of the hospital, and/or helps you live longer.

2. Which medicines might I be able to stop with minimal risk to my health? There aren’t always easy answers to this question. You may need to do your own research to make a shared decision with your doctor.

3. Are there lifestyle changes I can make now that might let me stop some of my medications? For conditions such as high blood pressure and type 2 diabetes, lifestyle changes such as exercising more and following a healthier diet can often decrease the number and dose of drugs you take.

Here are some other cost-saving tips:

If you have a prescription drug plan, ask your doctor to prescribe drugs that are “preferred.” These will be the least expensive.

2. Ask your doctor or pharmacist if a generic version of your medication is available.

3. If no generic is available, ask your doctor or pharmacist if a less-expensive brand name drug in the same medication family would work as well.

4. Ask your doctor or pharmacist about pill splitting. With some medications, there’s little or no cost difference between low-dose and high-dose pills. With a $5 pill splitter, you can buy the higher-dose version and save 50 percent.

5. Shop around. Even with prescription medications, prices can vary a lot. I recently compared the price of a commonly prescribed antibiotic. I found one major drug store that charged one-third the price compared to another.

(Howard LeWine, M.D., is Chief Medical Editor, Internet Publishing, Harvard Health Publications.)