About four in 10 American adults say they did not take a medication as prescribed in the past year because of what it cost, and roughly a third say they skipped or postponed health care they needed for the same reason.
Those figures come from KFF polling, and the prescription number has moved sharply. Three years earlier, about 31% reported such measures. The share now stands at 43%.
What makes the polling useful is not the headline percentages but the breakdown underneath them, which shows what people actually do when a medication costs more than they can manage.
The Specific Behaviors Behind the Number
The 43% figure aggregates several distinct actions, and they carry different clinical consequences.
About three in 10 adults, or 31%, said they took an over-the-counter drug instead of getting a prescription filled. Roughly a quarter (27%) said they did not fill a prescription at all. And about one in five, 19%, said they cut pills in half or skipped doses because of the cost.
Those are not equivalent. Substituting an over-the-counter product may be reasonable for some conditions and useless or harmful for others, since no over-the-counter drug substitutes for an antihypertensive, an antidepressant or an insulin. Not filling a prescription means going without entirely. Splitting pills or stretching doses means taking a medication at an unintended dose, which for some drugs reduces effectiveness and for others creates genuine danger.
This is the point where a caution belongs. Some formulations cannot be split safely at all, including extended-release tablets and enteric-coated products, where cutting the tablet delivers the entire dose at once or destroys the protective coating. Anyone considering stretching a prescription should ask a pharmacist first, because pharmacists can often identify a cheaper path that does not involve underdosing.
The consequences are not hypothetical. KFF has found that nearly one in five adults said their health got worse because they skipped a doctor's visit, a share that rises to 42% among adults 64 and younger.
The Reason Insurance Does Not Settle It
Having coverage helps and does not resolve the problem. Among adults under 65, 58% of the uninsured said they had not taken medicine as prescribed because of cost, compared with 43% of the insured.
That 43% among insured adults is the number worth sitting with. Insurance shifts cost rather than eliminating it, and several mechanisms produce out-of-pocket exposure.
Deductibles must be met before most coverage begins, which means someone on a high-deductible plan pays the full negotiated price for medications early in the year. Copayments and coinsurance apply afterward, and coinsurance in particular scales with drug price, so an expensive medication remains expensive at 20% of the cost.
Formulary tiers determine which drugs cost what, and a medication a clinician selects may sit on a tier requiring substantially higher payment. Prior authorization can delay a fill for days or weeks. Out-of-network care and facility fees add further exposure on the services side.
Income tracks all of it. About half of adults in households earning under $40,000 reported taking at least one of these prescription cost-saving measures, and 47% of those in households between $40,000 and $90,000, compared with three in 10 in households earning $90,000 or more. Larger shares of uninsured, Black and Hispanic adults and of women report taking these measures. Among adults taking four or more prescription medications, 64% reported worry about affording them, and worry among adults in households under $40,000 stood at 67%.
The Measurement Question Readers Should Understand
These are self-reported survey responses about behavior over the previous 12 months, not observed or verified treatment records, and that distinction affects how the numbers should be read.
Federal survey data using different question wording produces substantially lower figures. As the Peterson-KFF Health System Tracker notes, about 8% of adults reported rationing prescribed medication due to cost and 6% did not get needed medication to save money.
Neither is wrong. The KFF questions ask about a broader set of behaviors across a full year and include actions like substituting an over-the-counter product that a narrower question would not capture. Recall over 12 months is also imperfect in both directions.
The consistent finding across sources is directional rather than precise: a substantial share of Americans modify how they take medication because of cost, the share is larger among lower-income and uninsured people, and it has been rising. KFF found 59% of adults worried about affording prescription drugs, the largest share since the question was first asked in 2018, and separate polling found health care to be the household expense people worry about most, ahead of utilities, food, rent and transportation.
The Options Worth Asking About Before Rationing
Several routes exist that people frequently do not know to request, and asking costs nothing.
Pharmacists can identify generic equivalents, therapeutic alternatives within the same drug class at lower cost, and 90-day supplies that often reduce per-dose price. Prescription discount programs sometimes price a drug below an insurance copay, and a pharmacist can check both.
Manufacturer patient assistance programs cover many brand-name drugs for people meeting income criteria. Medicare beneficiaries with limited income may qualify for Extra Help with Part D costs, and some states run additional pharmaceutical assistance programs.
Federally qualified health centers provide care and often pharmacy services on a sliding fee scale regardless of insurance status. Hospitals maintain financial assistance policies that patients generally must apply for rather than being offered.
The most important step is telling the prescriber. Clinicians frequently do not know what a medication will cost a specific patient under a specific plan, and cannot substitute an alternative they are not told is needed. MedicalDaily has covered how Medicare drug price negotiation may change what patients pay and what coverage losses do to local health systems.
Key Questions Answered
What did the polling find? About 43% of US adults said they did not take medication as prescribed in the past year because of cost, up from 31% three years earlier. Roughly a third also reported skipping or postponing needed health care over cost.
What does not taking medication as prescribed mean in practice? It combines three behaviors: 31% took an over-the-counter drug instead of filling a prescription, 27% did not fill a prescription, and 19% cut pills in half or skipped doses.
Is splitting pills safe? Not always. Extended-release tablets and enteric-coated products can be dangerous when split, because cutting them can release the full dose at once or destroy a protective coating. A pharmacist should be asked first.
Does insurance solve the problem? No. Among adults under 65, 43% of insured people still reported not taking medication as prescribed due to cost, compared with 58% of the uninsured. Deductibles, copays, coinsurance, and formulary tiers all create out-of-pocket exposure.
How reliable are these numbers? They are self-reported survey responses covering 12 months, not verified treatment records. Federal surveys using narrower questions report substantially lower figures, around 8% for rationing medication. The consistent finding across sources is the direction and the income gradient rather than a precise share.
Who is most affected? About half of adults in households earning under $40,000 reported taking at least one prescription cost-saving measure, against three in 10 in households earning $90,000 or more. Uninsured adults and people taking four or more medications report the highest levels of worry.
What should someone do before rationing a medication? Tell the prescriber and ask a pharmacist about generics, therapeutic alternatives, 90-day supplies and discount programs. Manufacturer assistance programs, Medicare Extra Help, community health centers and hospital financial assistance policies are also worth asking about.
