5 Major Issues Keeping Patients From Life-Saving Medication

Drug pricing has been a topic of increased focus in the US as challenges to keeping on prescribed medication have become more clear.¹ Pharmacy benefit managers (PBMs) have come under fire for their role in driving up the price of drugs, as the 3 largest PBMs manage 79% of prescription drug claims and reports have shown that PBMs inflate drug costs through unclear pricing and utilization schemes.² The Trump administration signed an executive order in May that aimed to lower drug prices by up to 59%, which comes after the Inflation Reduction Act was signed in 2022 to help the government negotiate prices directly for people on Medicare.³

These actions seem to acknowledge the difficulties surrounding the affordability of prescription drugs in the US, but drug pricing remains a major factor in adherence to medication. With the recent House budget proposing huge cuts to Medicaid, these problems may be exacerbated.⁴ The new State of Drug Access 2025 report from Razormetrics details the number of ways that patients are having difficulty accessing their drugs and maintaining their regimen.⁵

1. Patients Prescribed Unaffordable Medication

Approximately 42% of those surveyed for this report claimed they were prescribed medication they could not afford in the previous year. This is in line with a previous survey, conducted by KFF, that demonstrated that 28% of adults had difficulty affording their prescription drugs, primarily people who received more than 4 medications.⁶ The report also showed that medication was stopped in more than 11% of people due to the cost of the medication.⁵ About 84% of the surveyed individuals also reported they were shocked by prices below $250 for medications, indicating that patients are not able to prioritize their health due to the increased cost burden of the drugs they’re prescribed.

2. Confusion in Medicine Complicates Adherence

Patients reported confusion in both polypharmacy and pricing that made adherence difficult. Individuals who were taking at least 5 medications described being overwhelmed or confused due to cost layering, chaos surrounding their refills, and emotional fatigue. With approximately 33% of adults in the US reporting using 5 or more prescription drugs, according to the CDC, this can be a major problem for millions in the country.⁷ However, it is not only those who have more than 1 medication that report confusion. A total of 53.1% of the individuals said they did not understand the cost of the medication they were prescribed, showing a lack of communication between them and their doctor when establishing the cost preference for the patient.

Multiple challenges exist for people to receive life-saving medication at an affordable price and with consistency. | Image credit: Eric Hood - stock.adobe.com

3. First Contact for Patients Remains Their Doctor Regarding Cost

A total of 47.2% of individuals surveyed were found to more often call their doctor regarding the cost of their medication than reaching out to their insurance company or using other modes of seeking a discount on their medication. However, even if patients are more likely to reach out to their doctor than any other professional, studies have shown that these conversations may not be happening frequently.⁸ Lumicera Health Services found that although 75% of the 2000 adults surveyed were surprised by their medication cost, 74% of them had never discussed these costs with either their doctor or their pharmacist. Taken into consideration alongside most patients’ confusion surrounding the use of their medication, patients are trending toward not openly communicating with their provider to help them keep on their medication.

4. Lowest Cost Available Preferable for Most Patients

The majority of patients (90%) indicated they would prefer a medication that was lower in cost than the treatment they were currently on, with 85.5% wanting their doctor to default to the lowest-cost medication that would be able to treat them. Generic drugs are usually lower-cost alternatives that have largely been proven to be just as effective as brand name drugs across the board due to their similar chemical makeup.⁹ Allowing patients to talk to their doctor about offering generic products rather than defaulting to name products can help to lower the cost of medication for patients throughout the country.

5. Patients Not Aware of Low-Cost Alternatives

Given this, the lack of knowledge surrounding biosimilars is also a problem within this space, with 81.7% of individuals questioned for the report saying that they had never heard of biosimilars before. According to the Biosimilars Council and Association for Accessible Medicines,¹⁰ biosimilars saved $12.4 billion in 2023 and $36 billion overall through September 2024. There have been 64 approvals of biosimilars in the US, with approvals spanning disease states that include neovascular age-related macular degeneration, colorectal cancer, rheumatoid arthritis, Crohn disease, and other chronic conditions, giving individuals options for how they can be treated.¹¹ Patients could be saving more on their medication through education on their various options, which may not always be explained to them.

References

1. HHS, CMS set most-favored-nation pricing targets to end global freeloading on American patients. News release. HHS; May 20, 2025. Accessed May 27, 2025. https://www.hhs.gov/press-room/cms-mfn-lower-us-drug-prices.html

2. McNulty R. 5 things to know about PBMs’ influence on drug costs and access. AJMC^®. August 2, 2024. Accessed May 27, 2025. https://www.ajmc.com/view/5-things-to-know-about-pbms-influence-on-drug-costs-and-access

3. Bonavitacola J. Trump executive order could reduce pharmaceutical costs by 59%. AJMC. May 12, 2025. Accessed May 27, 2025. https://www.ajmc.com/view/trump-executive-order-could-reduce-pharmaceutical-costs-by-59-

4. Shaw M. Proposed GOP Medicaid cuts threaten loss of coverage for millions. AJMC. May 12, 2025. Accessed May 27, 2025. https://www.ajmc.com/view/proposed-gop-medicaid-cuts-threaten-loss-of-coverage-for-millions

5. State of drug access, 2025. Razormetrics. 2025. Accessed May 27, 2025. https://20916206.fs1.hubspotusercontent-na1.net/hubfs/20916206/Brochures/State%20of%20%20Drug%20Access,%202025%20Whitepaper.pdf

6. Sparks G, Kirzinger A, Montero A, Valdes I, Hamel L. Public opinion on prescription drugs and their prices. KFF. October 4, 2024. Accessed May 27, 2025. https://www.kff.org/health-costs/poll-finding/public-opinion-on-prescription-drugs-and-their-prices/

7. The dangers of polypharmacy and the case for deprescribing in older adults. National Institute of Aging. August 24, 2021. Accessed May 27, 2025. https://www.nia.nih.gov/news/dangers-polypharmacy-and-case-deprescribing-older-adults

8. Survey reveals: Americans surprised by prescription costs but rarely discuss financial challenges with pharmacists. News release. Lumicera Health Services; April 10, 2025. Accessed May 27, 2025. https://www.businesswire.com/news/home/20250410384684/en/Survey-Reveals-Americans-Surprised-by-Prescription-Costs-but-Rarely-Discuss-Financial-Challenges-With-Pharmacists

9. Do generic drugs compromise on quality? Harvard Health Publishing. February 12, 2021. Accessed May 27, 2025. https://www.health.harvard.edu/staying-healthy/do-generic-drugs-compromise-on-quality

10. Biosimilars medicines saved $12.4 billion in 2023. News release. Biosimilars Council; September 5, 2024. Accessed May 27, 2025. https://biosimilarscouncil.org/news/biosimilar-medicines-saved-12-4-billion/

11. Biosimilars approvals. The Center for Biosimilars^®. Updated January 7, 2025. Accessed May 27, 2025. https://www.centerforbiosimilars.com/biosimilar-approvals