Cost Barriers to Medication Adherence and How to Get Help

Every year, medication adherence saves lives. But for millions, taking pills as prescribed isn’t a choice-it’s a luxury they can’t afford. In the U.S., nearly 1 in 5 adults skip doses, split pills, or skip refills entirely because they can’t pay. It’s not laziness. It’s not ignorance. It’s hunger, rent, and a $500 insulin bill staring back from the pharmacy counter.

Why Cost Stops People From Taking Their Medicine

It’s simple math: if your monthly co-pay for blood pressure meds is $75 and your paycheck only covers groceries and utilities, you’ll pick the groceries. That’s what 8.2% of working-age adults did in 2021, according to the CDC. For older adults on Medicare, it’s even worse-14.4% admitted to cutting back on meds because of cost.

The problem isn’t just high list prices. It’s how the system layers costs on top of each other: deductibles, coinsurance, tiered formularies, and surprise price hikes at the counter. A study in the American Journal of Managed Care found that when co-pays jumped above $50, adherence dropped by 15-20%. For insulin, some patients pay over $800 a month-even with insurance. That’s not a prescription. That’s a financial trap.

Cardiovascular drugs are especially hard to afford. People with heart disease are more likely to skip doses than those with diabetes or cancer, even though skipping those pills can lead to heart attacks, strokes, or hospitalizations. One 62-year-old Medicare beneficiary told Kaiser Health News she pays $350 a month for her meds after coverage. She chooses between pills and groceries. That’s not a decision anyone should have to make.

Who Gets Hit Hardest

Cost-related nonadherence doesn’t affect everyone equally. Low-income households, especially those earning under $25,000 a year, are 3.2 times more likely to skip meds than those earning over $75,000. Women, younger adults, and non-white patients are also disproportionately affected. Many say they’ve had to choose between medicine and heating their home, paying for childcare, or buying food.

Even people with insurance aren’t safe. The U.S. spends more per person on prescription drugs than any other developed country. In 2021, out-of-pocket spending on retail drugs hit $63 billion. That’s not just a statistic-it’s a mother skipping her asthma inhaler so her child can have school lunches. It’s a veteran rationing his diabetes pills because his copay went up $30 last month.

Real Stories, Real Consequences

Reddit threads are full of raw, unfiltered accounts. One user wrote: “I’ve been splitting my 20mg Lisinopril pills in half because $120 for a 30-day supply is too much. My BP is still high.” Another shared: “I took my insulin every other day for six months. I thought I was being smart. I ended up in the ER with diabetic ketoacidosis.”

These aren’t rare cases. The American Heart Association estimates that 125,000 Americans die each year because they didn’t take their meds as directed. That’s more than traffic accidents or gun violence. And the financial toll? Between $100 billion and $300 billion in avoidable hospital visits, ER trips, and complications every year.

How to Get Help: Practical Steps You Can Take Today

You don’t have to suffer in silence. There are real, working solutions-but you have to ask for them.

• Ask your doctor to check your formulary. Not all drugs are created equal in cost. Your doctor can switch you to a generic, a lower-tier drug, or one on your plan’s discount list. The American Medical Association says this is the single most effective step providers can take.
• Use GoodRx or SingleCare. These free apps compare prices at nearby pharmacies. You can save 50-80% on brand-name and generic drugs. In 2023, 35 million Americans used them monthly. A $400 insulin prescription can drop to $35.
• Ask for a 90-day supply. Many insurers charge less per pill when you get a 3-month supply through mail-order. You’ll save 20-30% and reduce how often you have to pay.
• Apply for patient assistance programs. Pharmaceutical companies run these programs for people with low income. Eligibility? Usually under 400% of the federal poverty level ($55,520 for one person in 2023). One type 2 diabetes patient went from paying $500/month for insulin to $25 after enrolling. Her adherence jumped from 60% to 95%.
• Check if you qualify for Medicare Extra Help. If you’re on Medicare and have limited income, this program can cover up to $5,000 in annual drug costs. Apply at SSA.gov or call 1-800-MEDICARE.
• Ask for samples. About 32% of patients who struggle with cost get free samples from their doctor. It’s not a long-term fix, but it can buy you time to apply for other help.

What’s Changing in 2025 and Beyond

The Inflation Reduction Act brought major changes starting in 2025. For Medicare beneficiaries, out-of-pocket drug costs are now capped at $2,000 per year. The infamous “donut hole” is gone. And for the first time, you can pay for high-cost medications in monthly installments instead of one big bill.

The FDA approved over 1,100 generic drugs in 2022, bringing down prices for older medications. Real-time benefit tools (RTBTs) are now used by 78% of large health systems. These tools show your doctor the exact price of a drug before they write the prescription-so you’re not blindsided at the pharmacy.

But these changes don’t fix everything. A 2022 study found that RTBTs still get prices wrong 37% of the time. And while insulin prices are finally being capped under Medicare, they’re still sky-high for people without Medicare.

What You Can Do Right Now

If you’re skipping doses because of cost, you’re not alone. But you’re not powerless.

Start by talking to your doctor. Say: “I can’t afford this. Can we find something cheaper?” Most doctors now ask about cost-65% do it routinely, up from 42% in 2019. They want to help. You just have to speak up.

Download GoodRx. Call your pharmacy. Ask if they have a discount program. Check Patient Services Inc. or the Partnership for Prescription Assistance. These organizations connect people with free or low-cost meds.

Don’t wait until you’re sick. Don’t wait until your blood pressure spikes or your blood sugar crashes. The system is broken-but help exists. You just have to reach for it.

Frequently Asked Questions