Addressing the Threat of Prescription Abandonment

Sticker shock at the pharmacy counter has become an all-too-familiar experience for both patients and providers. The rising cost of prescription medications in the United States creates a growing obstacle for millions of people.

In 2022, more than 4,200 drug products experienced price increases (many of which were higher than the rate of inflation), compared to the 1,200 drugs that saw price increases the year before.^1,2 For patients, this meant the average price of a drug rose 15% in 2022 up from 2021 which saw an increase of 11.5%. With over half of adults³ worried about affording their family’s prescriptions, today, patients are put between a rock and a hard place: pay out-of-pocket prices they can’t afford or walk away empty-handed.

Information from the Centers for Disease Control and Prevention found that 8.2% of adults (nearly 9.2 million people) aged 18-64 did not take their medications as prescribed in 2021.⁴ Among those studied, uninsured adults (22.9%) were the most likely not to take medications as prescribed to reduce costs. Creating a ripple effect, rising prescription costs lead to an increase in nonadherence measures, such as skipping doses, reducing doses, delaying prescription refills, or forgoing a fill altogether, which can become harmful, or even fatal, over time.

To address these challenges and mitigate medication abandonment, pharmacists can leverage a variety of tools and strategies that provide transparency, immediate access to savings and comprehensive patient support. Solutions, such as real-time prescription pricing tools, patient assistance programs, and digital adherence platforms, empower patients to better understand their medication costs, locate convenient pharmacies and take a proactive role in managing their prescribed therapies. Through a multifaceted approach, these tools can support providers and patients in deciding on cost-effective therapy options, which may significantly reduce out-of-pocket (OOP) costs and prescription abandonment rates, thereby improving the overall patient experience. These resources can help patients and providers make value-based decisions about treatment and help patients decrease their OOP costs, reduce their abandonment of prescriptions, and help patients have a better overall experience.

The rising challenge of prescription abandonment

Medication abandonment and nonadherence are particularly worrisome for patients with lower incomes.

It has been reported that patients from medically underserved areas abandon prescription medications used to treat diabetes, hypertension, and cholesterol-lowering agents at a higher rate (5.44%) compared to their counterparts at (4.77%).⁵Additional data from IQVIA states that the average out-of-pocket cost per retail prescription rose in 2023, further burdening patients to prioritize between vital medications and other essential expenses. Later findings indicated that when OOP costs exceeded $250, 69% of patients did not start therapy,⁶ but when OOP costs were less than $30, the abandonment rate was only 11%. Another report found that prescriptions subject to deductibles were twice as likely to be abandoned at the pharmacy counter, meaning people on high-deductible plans were opting out of taking their prescribed medicine.⁷ For those with chronic conditions, a study conducted by a research team from the University of Michigan found that higher OOP costs, sometimes by an increase of $50, resulted in lower medication adherence rates.⁸

Any doctor can underscore the importance of taking medication as prescribed and the serious implications that may happen if a regimen isn’t followed. Unfortunately, when patients are burdened by costs, they may struggle to fully grasp the long-term value of their medications. Driven by the immediate need for financial relief, they may resort to difficult decisions, like skipping doses or self-adjusting their prescribed regimens, inadvertently diminishing the effectiveness of vital therapies. The long-term consequences of this pattern of nonadherence extend beyond immediate health risks. Nonadherence can lead to worsening symptoms and disease progression, prolonged hospitalization, and an increase in overall healthcare costs. In fact, reports indicate that the estimated annual cost of illness or disease caused from nonoptimized medication therapy was $528.4 billion.⁹

Strategic approaches to enhance patient adherence

Patients face several unknown factors when they go to the pharmacy counter. Information about the costs, medication availability, the wait time to fill, and in some cases, a patient's insurance coverage of their prescriptions may not be the most affordable option. High copays, deductibles, and non-preferred coverage for certain medications should not be an obstacle to good health. To best address these challenges and improve patient adherence, pharmacists can advocate for a number of actionable strategies:

• Leveraging real-time prescription pricing tools: Patients who receive access to real-time medication price estimates are better equipped to make informed choices and gain confidence in knowing what to expect at the point of sale. This level of transparency helps reduce uncertainty and can strengthen patients’ trust in the broader healthcare system. Pharmacies can work with healthcare vendors to provide inventory and pricing data to enhance the effectiveness of real-time pricing tools. With greater participation from pharmacies, more patients can access a comprehensive overview of their choices. When utilized, a pricing tool can potentially save patients up to 80% on the usual and customary price of their prescription.
• Prescription discount cards: Even patients with insurance may find prescription costs higher than expected due to high deductibles or co-pays. Pharmacists can recommend prescription discount cards as an alternative that provides lower prices and is often more affordable than the OOP expenses through some insurance plans. By offering a discount card as an alternative, patients may save significantly on medications, which can reduce the financial strain of insurance-based costs. Pharmacists can help patients compare the costs between using insurance and a discount card to ensure they are making the most cost-effective choice, especially for medications not covered under their plan.
• Patient assistance programs (PAPs): PAPs offer relief to eligible patients struggling with medication costs, particularly those who are uninsured or underinsured. By covering the full cost of select medications for qualifying patients, these programs not only ease financial strain but also help bridge critical gaps in care. The benefits are clear: a 2025 study on patients with diabetes found that A1C levels and medication utilization were considerably improved for patients who could get high-cost medications through PAPs.¹⁰ Pharmacists ​​play an essential role in identifying patients who may qualify for PAPs, educating them about the programs available to them, and assisting with complex application processes. By actively promoting these key programs, pharmacists are directly positioned to improve access and adherence.
• Manufacturer coupons: A common tool for new product launches or to help patients manage high co-pays, manufacturer coupons provide direct discounts on certain brand-name medications at the pharmacy counter. Manufacturer coupons make otherwise expensive brand-name drugs more affordable and reduce the likelihood of abandonment at the point of sale. Pharmacists are at the forefront of informing patients about applicable manufacturer coupons, and their expertise ensures patients maximize these savings opportunities and proceed with their prescribed therapy.
• Co-pay programs: Co-pay programs help patients manage high co-payments for their prescriptions, making expensive therapies more accessible by capping the patient's OOP contribution. A recent HealthWell Foundation survey revealed that31% of seriously ill patients who were using charitable copayment assistance could not access their necessary treatment without it.¹¹ This signals how essential these programs are for maintaining continuous, life-saving care. Pharmacists can identify when a patient's co-pay is unusually high and guide them to relevant co-pay assistance programs, reducing financial pressure on patients and fostering adherence.
• Community health centers: These are often the pivotal access point for underserved populations. Community health centers improve patients’ access to affordable medications, medication counseling, and adherence support, as well as direct dispensing services. Most importantly, these facilities address not only medication needs but also broader health and social determinants. Many community health centers offer sliding scale fees or discounted services, which help patients access necessary medications without having to choose between healthcare and other financial needs. Working within or alongside these centers allows pharmacists to extend their reach to vulnerable populations, ensuring patients receive the affordable care options they need in a supportive environment.

Creating a healthier society

When deploying integrated patient support tools, everyone wins. If patients can access their medications at prices they can afford, adherence increases, creating healthier lives in the community. At the same time, as adherence increases, prescription volume for pharmacies increases, too. Patient loyalty and trust could also improve if more affordable prices are consistently offered at a patient’s preferred pharmacy.

Growing awareness

A key component to these accessibility and affordability tools is in large part powered by awareness. In order to drive meaningful impact, we need to go beyond simply offering these tools, but actively promote them. Traditional insurance coverage for medications is not the only solution. Pharmacists and healthcare organizations can work together to educate their audiences about readily available healthcare affordability strategies, especially if a patient expresses concerns about the cost of their prescriptions at the counter. Grassroots efforts—such as partnerships with community organizations, public health campaigns, and multilingual resources—can further enhance awareness and access, especially in populations most at risk for nonadherence due to affordability challenges.

The future of prescription access

Technology is reshaping the future of healthcare by removing long-standing barriers such as time, high OOP costs, and unequal access to essential medications. When done thoughtfully, digital patient-centric solutions can transform the pharmaceutical industry shifting the focus towards stronger and more personalized care.

About the Author

Alexandra Robertson is the Senior Vice President of Growth at Visory Health.

References

1. Bosworth A, Sheingold S, Finegold K, Sayed BA, De Lew N, Sommers BD. Changes in the List Prices of Prescription Drugs, 2017-2023. Office of the Assistant Secretary for Planning and Evaluation. October 6, 2023. https://aspe.hhs.gov/reports/changes-list-prices-prescription-drugs

2. Bosworth A, Sheingold S, Finegold K, Sayed BA, De Lew N, Sommers BD. Price Increases for Prescription Drugs, 2016-2022. Office of the Assistant Secretary for Planning and Evaluation. September 30, 2022. https://aspe.hhs.gov/reports/prescription-drug-price-increases

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4. Mykyta L, Cohen RA. Characteristics of Adults Aged 18–64 Who Did Not Take Medication as Prescribed to Reduce Costs: United States, 2021. Centers for Disease Control and Prevention’s National Center for Health Statistics. June 2023. https://www.cdc.gov/nchs/data/databriefs/db470.pdf

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6. Devane K, Harris K, Kelly K. Patient Affordability Part Two. IQVIA. May 18, 2018. https://www.iqvia.com/locations/united-states/library/case-studies/patient-affordability-part-two

7. Deductibles and Coinsurance Drive High Out-Of-Pocket Costs for Commercially Insured Patients Taking Brand Medicines Pharmaceutical Research and Manufacturers of America. November 14, 2022. https://phrma.org/resources/deductibles-and-coinsurance-drive-high-out-of-pocket-costs-for-commercially-insured-patients-taking-brand-medicines

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