The Cost Is Still Too High: Why Low-Income Employees Struggle to Fill Their Prescriptions

After years of rising healthcare spend, employers are finally asking the right question: “Are our benefit dollars actually helping people?” The answer, for many low-income employees, is no.

A recent West Health-Gallup poll found that 30% of U.S. adults skipped medication in the past 12 months due to cost, despite having health insurance. The same survey showed that 14% experienced severe health consequences as a result. This issue transcends public health, manifesting as a workforce performance challenge.

Even as more employers expand coverage to address chronic conditions, behavioral health, and specialty drug access, the final step of ensuring employees can afford and fill their prescriptions continues to break down. For workers living paycheck to paycheck, confusion and cost at the pharmacy counter remain the primary barriers to adherence.

These aren’t fringe cases. Lower-income patients with chronic conditions are more likely to abandon first-time prescriptions than their higher-income peers, even when the drug is covered. That abandonment isn’t showing up in claims data until it’s too late.

When a $15 Copay Becomes a Wall

It’s easy to underestimate how quickly a modest out-of-pocket charge becomes prohibitive for an employee living paycheck to paycheck. Even modest prescription costs compete with housing, food, and childcare for many working Americans. Past studies have found prescription abandonment is under 5% when patients owe nothing but jumps to 45% when out-of-pocket costs exceed $125, and to 60% when costs top $500. 

When employees don’t know what they’ll owe until they’re standing at the pharmacy counter, or don’t understand their formulary or discount options, they often make the safest decision they can: walk away. Unfortunately, what feels financially secure in the short term usually carries a steep clinical and financial cost. For example, skipping a $15 antihypertensive prescription could lead to a $4,000 ER visit or hospitalization later. These episodes impact patient health, destabilize claims budgets, and increase volatility across self-insured plans.

The real issue isn’t always price. It’s predictability, and employers can help solve that problem.

Coverage Without Coordination Creates Hidden Risk

According to a 2025 IQVIA Institute report, 27% of new prescriptions go unfilled, with a large portion attributed to benefit design and cost uncertainty. This strongly signals that addressing cost barriers upfront can help reduce non-adherence. Many employers rely on retrospective claims analysis to identify cost drivers and clinical risk, but claims only reflect what gets filled. If employees aren’t starting treatment in the first place, the risk is invisible until it’s not. 

A more proactive model looks at prescription behavior through the lens of affordability and accessibility, treating cost as a primary barrier to clinical success. Forward-thinking employers are shifting from reactive to proactive strategies, leveraging pharmacy insights to identify and address cost barriers of prescribing, when intervention is most impactful and affordable.

Trust Is in the Exam Room, Not the App Store

One of the most cited frustrations in an AHIP Health Experience Survey wasn’t price, it was fragmentation. Patients are weary of juggling coupon platforms, insurer portals, and third-party apps that promise savings but often cause confusion. Only 28% of consumers believe these online tools are among their plan’s most important value-added services.

Instead, employees want a simple answer from someone they already trust: their physician. However, for doctors to serve that role effectively, they need tools that don’t disrupt their already busy schedules; tools that quietly alert them to a possibly unaffordable prescription and highlight covered, cheaper alternatives. No pop-ups, no new dashboards – just built-in support within their prescribing workflow.

This is where intelligent, clinically integrated solutions can deliver tangible results. When a potential cost barrier is detected, these systems immediately surface clinically appropriate, lower-cost alternatives to prescribers. Patients are notified proactively, enhancing their likelihood of adherence. 

This kind of passive intervention doesn’t disrupt care; it enhances it. It also enables employers to reduce pharmacy costs without shifting more burden onto patients or providers. 

Rebuilding Trust at the Point of Care

Employers can better address prescription access by aligning their pharmacy benefit investments with the real-world experiences of their workforce.

That means:

• Reducing friction between clinical decision-making and affordability data.
• Supporting prescribers with automated, client coverage information, without adding administrative burden.
• Simplifying the path to adherence by eliminating guesswork and last-minute surprises at the pharmacy counter.

These interventions don’t require an overhaul of benefit design. They require coordination and the willingness to shift focus from claims analysis to behavior prediction.

The Outcome That Matters Is Access

Rising benefit costs will not deliver ROI unless they are translated into action, and action starts with access. For low-income employees, affordability is the defining variable in whether they start and stay on prescribed treatments. Employers that address this gap early, through smarter coordination with prescribers and more intuitive tools for patients, can reduce unnecessary spend, improve workforce health, and close one of the most persistent access gaps in modern healthcare.

Coverage is only valuable if employees can afford to use it. Employers don’t need to overhaul their benefits structure to make meaningful improvements. By utilizing claims-based analysis to inform proactive behavioral interventions, employers can reduce costly downstream medical events and enhance workforce health and productivity.