Prescription Drug Prices and Their Impact on Patient Adherence

Various publications revealed that the cost of medications is one of the primary causes of not filling a new prescription or taking a medication as prescribed. In a recent poll published in August 2023, researchers sought to assess the opinions of patients about the prices of prescription drugs. In this poll, among respondents, 61% stated that they were currently taking prescription drugs, with 13% taking at least 1 prescription drug, 11% taking 2 prescription drugs, 10% taking 3 prescription drugs, and 27% currently taking 4 or more prescription medications.¹ About the cost of prescription medications, 82% stated that the costs of prescription drugs are “unreasonable,” and 65% stated that affording prescription medication is either “very” or “somewhat easy.”¹ A major issue for patients currently taking 4 or more prescription medicines was affordability, with an estimated 40% of participants indicating challenges affording their prescriptions compared to 20% of adults taking 3 or fewer prescription medications.¹

In the past year, an estimated 3/10 adults reported not taking their medicines as prescribed at some point due to costs, which includes about 1:5 not filling a prescription or taking an over-the-counter drug instead (21%), and 12% who reported cutting medications in half or skipping a dose because of the cost.¹ The survey findings indicated that many Americans favor implementing actions to lower the costs of medications. They stated, “The public sees profits made by pharmaceutical companies as the largest factor contributing to the price of prescription drugs. At least 8:10 participants stated profits made by pharmaceutical companies are a ‘major factor’ in the price of prescription drugs. This is followed by more than half who say the cost of research and development is a ‘major factor’ contributing to the price, and about half saying that the cost of marketing and advertising is a major contributing factor to the cost of prescription drugs.”¹

Other News and Data Highlighting the Impact of High Drug Cost on Adherence

According to a publication on the Blue Cross Blue Shield website, the high costs of medications have prevented an estimated 1 in 3 individuals in the US from taking prescription medications as prescribed. In the last decade, drug spending increased by 60%.² Research from the CDC indicates due to the high expense of prescriptions, more than 9 million adults in the US are not taking their prescription drugs as prescribed, and those without insurance are more likely not to fill or take medication as prescribed.3 Other critical findings included:

• In 2021, 8.2% of adults between the ages of 18 and 64 years reported that because of costs, they did not take medication as prescribed, with nonadherence rates of 9.1% for women and 7.0% for men.³

A recent publication in JAMA Network Open⁴ evaluated cost-related medication nonadherence, cost-coping tactics, and viewpoints on utilizing real-time benefit tools in clinical practice among older adults. Results revealed that 20.2% experienced medication nonadherence due to the cost of medications. The authors wrote, “In addition, 89.5% expressed interest in their physician using real-time prescription benefit tools. However, some indicated concern about their physician using a tool without discussing the prices shown and that inaccurate estimates could lead to medication nonadherence.”⁴

According to the 2023 US Generic & Biosimilar Medicines Savings Report, in 2022, as a result of utilizing FDA-approved generic and biosimilar drugs, the US health care system, which includes patients, employers, and taxpayers, saved an estimated $408 billion. More than 90% of prescriptions that were filled last year were generic or biosimilar medicines. The report also indicated that these 2 categories of drugs also accounted for less than 18% and less than 2% of total prescription drug spending and US health care spending, respectively. The authors wrote, “Generics also deliver value to patients. Ninety-three percent of generic drugs have copays under $20 (as compared to 59% of brand-name drugs), and their average copay is $6.16 (as compared to $56.12 for brands).”5 The authors also indicated that in 2022, the use of biosimilars resulted in a total savings of $9.4 billion for patients.⁵

Views From Pharmacists and Patients

Retail Pharmacist stated, “The costs of everything is high, and I often see patients even with insurance, especially those taking multiple medications, struggling to pay for their medications. Fortunately for some medications, there are generics which make some medications affordable and accessible to patients.”

Hospital Pharmacist stated, “When discharging a patient, especially those with multiple chronic conditions and multiple medications, the pharmacy team always works with the prescriber to make the drug regimens as simple as possible and also addresses the issue of cost with patients and their families. There have been cases when a patient really needs a medication and doesn’t get it filled because of the costs and then ends up being readmitted to the hospital because the medication was not taken because of the high costs, which results in more costs for the patient and health care system."

Patient with multiple comorbidities, including RA, stated, “With the high costs of day-to-day expenses and medications, it can sometimes be a challenge. When I went to get my 5 prescriptions filled, there was no way that I could afford all of them, and I almost didn’t get some of them, but my pharmacist told me about GoodRx, and with their coupons, I could afford all 5 of them.

Patient with hypertension and diabetes stated, “The costs of some medications are very high, even with insurance. My doctor took the time to consider the costs of medications because I was concerned about that, and she prescribed a generic medication for me. As a result, my copay was reasonable. I could not afford the out-of-pocket costs for one of the brand names and would not have been able to treat my hypertension and diabetes.”

Conclusion

The costs of medication and a patient’s ability to afford the prescribed medication can contribute to medication nonadherence and add to increased direct and indirect costs due to untreated medical conditions, resulting in exacerbations of medical conditions, increased rates of avoidable health care resource utilization, including ER visits, office visits, and hospital admissions. Research reveals that costs related to morbidity and mortality associated with poor medication adherence are an estimated $528.4 billion annually.⁶ The availability of generic medications and biosimilars for some brand name medications and originator biologic products provide patients with additional options that may make medication more affordable. However, some patients still struggle to obtain medications. Additionally, the various cost-savings programs available through manufacturers of many prescription drugs for eligible patients offer access to drugs at zero to minimal out-of-pocket costs are also beneficial, and more efforts are warranted to educate patients and prescribers about these programs. By making medications affordable and accessible, patients can take medications as prescribed, improve their health, and, in the long run, save money for the patients and the healthcare system because nonadherence is costly.

References

1. Public opinion on prescription drugs and their prices. KFF.org. Published August 21, 2023. Accessed November 21, 2023. https://www.kff.org/health-costs/poll-finding/public-opinion-on-prescription-drugs-and-their-prices/
2. New research: Insurers protecting Americans from rising drug costs. bcbs.com. Published March 16, 2023. Accessed November 21, 2023. https://www.bcbs.com/the-health-of-america/articles/insurers-protecting-americans-from-rising-drug-costs
3. Mykyta L, Cohen RA. Characteristics of adults aged 18–64 who did not take medication as prescribed to reduce costs: United States, 2021. NCHS Data Brief. 2023;(470). doi:10.15620/cdc:127680
4. Dusetzina SB, Besaw RJ, Whitmore CC, et al. Cost-related medication nonadherence and desire for medication cost information among adults aged 65 years and older in the US in 2022. JAMA Netw Open. 2023;6(5):e2314211. doi:10.1001/jamanetworkopen.2023.14211
5. Generic and biosimilar drugs generate $408 billion in savings for America’s patients and healthcare system in 2022. accessiblemeds.org. Published September 6, 2023. Accessed November 21, 2023. https://accessiblemeds.org/resources/press-releases/generic-biosimilar-drugs-generate-408-billion-savings-2022
6. Watanabe JH, McInnis T, Hirsch JD. Cost of prescription drug-related morbidity and mortality. Ann Pharmacother. 2018;52(9):829-837. doi:10.1177/1060028018765159