Cost Barriers to Medication Adherence and How to Get Help

Every year, 125,000 Americans die because they can’t afford to take their medicine as prescribed. It’s not because they don’t care-it’s because the price tag at the pharmacy is too high. You might think insurance covers everything, but for millions, out-of-pocket costs still make choosing between food, rent, or pills a daily reality. In 2021, 8.2% of adults under 65 skipped doses, cut pills in half, or didn’t fill prescriptions because of cost. That number jumps to 18% of all U.S. adults who say they’ve avoided filling a prescription due to price in the past year.

Why Cost Stops People From Taking Their Medicine

It’s not just about high list prices. The real problem is how costs are layered: copays, coinsurance, deductibles, and tiered formularies. A $50 copay for a blood pressure pill might sound manageable-until you’re paying that every month for three different medications. Studies show that when copays rise above $50, adherence drops by 15-20% compared to $10 copays. For people with chronic conditions like heart disease, diabetes, or asthma, this adds up fast.

One 62-year-old Medicare beneficiary told Kaiser Health News she pays $350 a month for her meds after her Part D coverage kicks in. That’s more than her monthly grocery budget. She cuts pills in half to make them last. That’s not rare. On Reddit, users share stories of paying $800 a month for insulin-even with insurance. The system isn’t broken; it’s designed this way. Drug companies set list prices, insurers negotiate discounts behind the scenes, and patients get stuck with the bill.

Cardiovascular medications show the strongest link between cost and nonadherence. People with high blood pressure or cholesterol often skip doses because they don’t feel sick. But skipping those pills increases stroke and heart attack risk. The American Heart Association says poor adherence directly causes tens of thousands of deaths each year. And the financial toll? Between $100 billion and $300 billion in avoidable hospital visits, ER trips, and complications annually.

Who Gets Hit the Hardest

Cost-related nonadherence doesn’t affect everyone equally. Low-income individuals, Black and Hispanic communities, women, and younger adults are far more likely to ration medication. A CDC study found that people with household incomes under $25,000 are 3.2 times more likely to skip doses than those earning over $75,000. Many choose between medicine and essentials like heating, food, or transportation.

Even people with Medicare aren’t safe. In 2016, 14.4% of older adults reported cutting back on meds because of cost. The “donut hole” in Medicare Part D used to leave seniors paying full price after hitting a spending cap. While that gap is closing by 2024, monthly premiums and copays still bite. And for those on multiple medications, the total can easily hit $500-$1,000 a month.

One woman in Ohio told her doctor she was giving her diabetic dog insulin before herself. She didn’t say it for sympathy-she said it because she believed her dog’s life was more valuable than hers. That’s the kind of desperation cost creates.

What You Can Do Right Now

You don’t have to accept these costs as inevitable. Here’s what actually works:

• Ask your doctor for alternatives. Not every brand-name drug is necessary. Generic versions cost 80-90% less and are just as effective. In 2022, the FDA approved over 1,100 new generics-many of them for high-cost conditions like diabetes and hypertension.
• Use GoodRx or SingleCare. These free apps compare prices at nearby pharmacies. One user saved $420 on her asthma inhaler just by switching stores. These tools can cut costs by 50-80% and are accepted at over 70,000 pharmacies.
• Ask for a 90-day supply. Many insurers charge the same copay for a 90-day supply as they do for 30 days. That’s a 20-30% savings per month. Mail-order pharmacies often offer this option too.
• Request samples. About 32% of patients who talk to their doctors about cost get free samples. It’s not a long-term fix, but it can buy time while you find a better solution.
• Check for manufacturer assistance programs. Drug companies run patient assistance programs for people with incomes under 400% of the federal poverty level ($55,520 for one person in 2023). One type 2 diabetes patient went from paying $500 a month for insulin to $25 after enrolling. These programs are easy to apply for online-often with just a few forms.

Don’t be afraid to say, “I can’t afford this.” Doctors are more willing to help than you think. A 2023 Medscape survey found that 65% of physicians now routinely ask patients about medication costs-up from 42% in 2019. You’re not being a burden. You’re helping them prescribe better.

Government and Insurance Help You Might Not Know About

If you’re on Medicare, you’re eligible for Extra Help, a federal program that pays for Part D premiums, deductibles, and copays. In 2023, it covered up to $5,000 in annual drug costs for qualifying individuals. Apply at SSA.gov or call 1-800-MEDICARE.

Starting in 2025, Medicare will cap out-of-pocket drug spending at $2,000 per year. That’s huge. But you don’t have to wait. You can also enroll in the new Medicare Monthly Payment Plan (M3P), which lets you pay for expensive drugs in installments instead of one big bill.

For non-Medicare users, check if your state runs a prescription assistance program. Many states offer subsidies for low-income residents. The Partnership for Prescription Assistance (PPA) helps connect people to over 475 programs and served over 1.2 million patients in 2022.

What’s Changing-And What’s Not

The Inflation Reduction Act brought real change. Insulin will cost no more than $35 a month for Medicare beneficiaries starting in 2023. That cap will expand to all insurers by 2025. The “donut hole” is disappearing. And real-time benefit tools (RTBTs) are now used by 78% of major health systems-they show doctors the exact cost of a prescription before they write it.

But here’s the catch: RTBTs are still inaccurate 37% of the time. A patient might be told a pill costs $20, only to be charged $50 at the counter. The system is improving, but it’s still messy.

Meanwhile, drug prices keep climbing. Between 2007 and 2017, insulin list prices jumped 368%-even though the cost to make it barely changed. The Congressional Budget Office predicts drug spending will hit $1.1 trillion by 2031. Without structural reforms, 1 in 5 Americans will keep skipping doses, even with insurance.

What to Do If You’re Already Behind

If you’ve missed doses or stopped taking meds because of cost, don’t wait until you’re sick. Start now:

1. Write down every medication you take and its monthly cost.
2. Call your pharmacy and ask for the cash price-sometimes it’s lower than your copay.
3. Search for each drug on GoodRx and SingleCare.
4. Go to NeedyMeds.org or RxAssist.org to find patient assistance programs.
5. Schedule a 10-minute call with your doctor and say: “I’m struggling to afford my meds. Can we find a cheaper option?”

One man with high blood pressure was paying $180 a month for his medication. He switched to a generic, used GoodRx to find the lowest price, and enrolled in his manufacturer’s assistance program. His new monthly cost? $7.

You can do this too. It’s not about being lucky. It’s about knowing where to look.

Next Steps

If you’re struggling to afford your meds, start today. Don’t wait for a crisis. Pick one thing from this list:

• Download GoodRx and check your next prescription’s cash price.
• Call your pharmacy and ask if they accept SingleCare.
• Search your medication name + “patient assistance program” online.
• Ask your doctor for a 90-day supply or generic alternative.

Medication adherence isn’t just about willpower. It’s about access. And access is something you can fight for. You’re not alone. Millions are in the same boat-and there are real, working solutions out there. Use them.