An Update on Americans' Access to Prescription Drugs

Originally published by the Center for Studying Health System Change (HSC) as Issue Brief No. 95, May 2005.

Prescription Drug Access Problems Growing Among Chronically Ill Americans

Increasing numbers of Americans, especially those with chronic conditions such as diabetes, asthma, and depression, were going without prescription medications because of cost concerns, according to a national study by the Center for Studying Health System Change. In 2003, more than 14 million American adults with chronic conditions, over half of whom had low incomes, reported being unable to afford all of their prescriptions.

Between 2001 and 2003, the proportion of privately insured, working-age people with chronic conditions who reported not filling at least one prescription because of cost rose from 12.7 percent to 15.2 percent. Among elderly Medicare beneficiaries without supplemental private insurance who had chronic conditions, the proportion reporting prescription drug affordability problems climbed from 12.4 percent to 16.4 percent over the same period. Significant disparities persisted between black and white Americans with chronic conditions, with blacks roughly twice as likely to report problems affording their medications.

Insurance Coverage Alone Does Not Solve the Problem

Having health insurance reduced prescription drug affordability problems but did not eliminate them. The growth in cost-related access problems among privately insured and Medicare populations reflected a combination of higher prescribing rates and increased patient cost sharing. As employers and insurers shifted more drug costs to patients through higher copayments and tiered formularies, even insured individuals faced growing financial barriers to filling their prescriptions. For the uninsured, the situation was far worse, but the trend among insured populations signaled that cost-sharing increases were crossing a threshold where they interfered with medication adherence among people who needed ongoing treatment for chronic conditions.

The findings carried significant implications for both individual health outcomes and overall health system costs. When patients with chronic conditions skip medications because of cost, their conditions tend to worsen, leading to emergency department visits, hospitalizations, and other expensive interventions that far exceed the cost of the medications they could not afford.

Sources and Further Reading

Reed, Marie C., "An Update on Americans' Access to Prescription Drugs," Issue Brief No. 95, Center for Studying Health System Change (May 2005).