When Medication is Too Expensive: The Real Price of Skipping a Dose

The high cost of prescription medication is one of the most pressing issues in healthcare. Millions of Americans face an impossible choice each month: pay for prescriptions or pay for basic necessities. The financial burden of many treatments like medications or infusions can be overwhelming for patients, who are often already struggling with the physical and emotional challenges of their conditions. Many specialty therapies carry high price tags, exceeding tens of thousands of dollars per year. Even insured patients are burdened with high deductibles and copays, which can lead to medical debt. These cost-related challenges are often referred to as “financial toxicity” and can have a detrimental effect on a patient’s economic stability and wellbeing, as well as their health. 

An Ecosystem Is in Place

While the problem is rooted in the complexity of the U.S. healthcare system, there are options available to improve affordability and access. Financial assistance programs are designed to lower the costs of medication if an individual doesn’t have insurance, is underinsured, or can’t afford the prescription. 

Pharmaceutical companies along with healthcare providers and pharmacies are working to improve affordability and access. According to various industry sources, collectively these companies have provided billions in financial assistance to ease patients’ out-of-pocket drug costs in the form of rebates, discounts, copay support, and manufacturer-sponsored patient assistance programs. In addition to manufacturers, copay foundations, government-sponsored programs, and other entities offer funding that can significantly reduce overall drug costs.  However, while these programs have played a critical role in helping the underinsured and vulnerable populations access life-saving medications, they are underutilized.

Access Challenges

Multiple barriers exist in accessing and navigating the financial assistance programs. One of the primary obstacles is visibility. Many patients are unaware there is financial support available, and most programs are not easily accessible or can be difficult to find. Compounding the challenges is that each program has its own eligibility criteria and enrollment requirements, which can create confusion and overwhelm applicants. Although many providers and specialty pharmacies provide support to help patients identify and enroll in available programs, the process is complex and time-consuming, which limits patient enrollment. When patients are unable to access assistance programs and can’t afford medication, it often results in treatment abandonment.      

According to the Center for Disease Control, an alarming 9.2 million Americans leave their prescriptions at the pharmacy, reporting high costs of drugs to be a driving factor. A 2024 survey by the Kaiser Family Foundation (KFF) supports these findings, stating that 55 percent of adults are worried about drug costs and many patients resort to drastic measures to stretch their prescriptions. These include cutting pills in half, skipping doses, or forgoing their refills. The groups most likely to abandon treatment due to cost are seniors, patients with chronic conditions or prescribed multiple medications, and the uninsured. However, even insured patients often face high copays or find that prescribed medications aren’t covered by insurance. The consequences of patients not adhering to treatments as prescribed are detrimental and include worsening of conditions, poorer quality of life, increased emergency room visits and hospital stays, lost work and wages, and in some cases, avoidable deaths. 

In addition to medication abandonment resulting in poor patient outcomes, it also creates a negative economic impact throughout the entire healthcare ecosystem. Treatment nonadherence places a heavier strain financially and functionally on healthcare providers, impacts pharmacies’ bottom lines, and could force pharmaceutical companies to make tough decisions to discontinue certain drugs. 

Streamlining Complexities and Eliminating Stress

One significant solution lies in tools and platforms that allows providers, pharmacies, and patients to shop for assistance programs more easily. Current methods to access patient assistance programs are labor-intensive, monopolize valuable resources, and searches are often not comprehensive. If patients have better support navigating financial resources, adherence to medication improves and so will overall health outcomes. Providers and pharmacies need to look toward technological innovations that can be integrated into their care models to find assistance programs and reduce drug costs for patients to support treatment continuity. 

While no single solution will fix the issues of healthcare costs overnight, providing patients with financial assistance so they can afford the medications they need to stay healthy is paramount. Life science companies, foundations, and other entities have taken the first step in providing funding to reduce these costs. The path forward relies on connecting these resources to patients in a manner that reduces friction and anxiety.