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Yahoo
19-05-2025
- Health
- Yahoo
Nearly a third of Americans aren't filling their prescriptions because of high costs
Healthcare professionals write millions of prescriptions every year to help Americans manage symptoms and treat a range of conditions. But affordability, access issues, and drug shortages prevent people from actually filling these prescriptions. GoodRx Research ran a 12-month survey to better understand the dynamics that shape prescription medication fills and consumer behavior. The following insights come from this survey of nearly 12,000 Americans. The findings highlight the significant financial and accessibility challenges people with and without insurance face in filling their prescriptions. According to a GoodRx Research survey, 29% of Americans leave prescriptions for medications unfilled due to cost. Cost is a barrier for people with and without insurance. Yet most patients don't talk about medication affordability with their prescriber. Drug shortages prevent 26% of Americans from accessing their prescribed medications. This includes access to essential medications like Ozempic, insulins, and some antibiotics. Unfilled prescriptions present serious health risks and long-term healthcare expenses. According to the GoodRx survey, 33% of Americans (52 million if extrapolated to the general population) had a prescription sent to the pharmacy that was ultimately not filled. So why aren't people filling these prescriptions? Medication cost is the main reason. People also forget to pick up their medications. Timing is another big issue. When people do go to the pharmacy, their medication may be out of stock. And many people just can't get to the pharmacy in time. This finding is alarming given that nonadherence, or not taking a medication as prescribed, can worsen chronic conditions. The high cost of medications can force people to make difficult choices between prioritizing their health and managing other essential expenses. In turn, this can lead to poor health outcomes and increased costs in the long run. Medication cost is the leading cause of unfilled prescriptions in the U.S. And this is an issue that affects people with and without health insurance. In fact, nearly a quarter of Americans are unable to fill their medication because their insurance doesn't cover it. When insurance doesn't cover a medication, patients are often on the hook for the full price. They may face financial strain and, ultimately, gaps in treatment and worsening symptoms. As it turns out, individuals who rely on the Affordable Care Act health exchange insurance plans have poorer coverage compared to other plan types. Among those on health exchange plans, 34% report a lack of prescription coverage. People with Tricare, Veterans Affairs (VA) insurance, or other military insurance have the highest rates of prescription coverage. GoodRx Research found that 23% of people spent more than $50 on their prescriptions per month (after removing respondents with Medicaid coverage). And nearly 10% reported spending over $100 on their prescriptions in the most recent month. And, once again, people with a health exchange plan, no insurance, or private insurance seem to pay more out of pocket on their prescriptions each month. Costs vary a lot for people with exchange plans. Only 19.7% pay nothing out of pocket and 2.9% pay $200 or more per month. This group, along with those enrolled in private insurance, appear to have the worst coverage for prescription medications. A substantial portion of their out-of-pocket costs falls into the mid-to-high cost brackets. Medicaid recipients, on the other hand, appear to have the most comprehensive prescription coverage. This finding is a reminder that prescription affordability will remain a barrier to medication adherence concern for many Americans until costs come down or insurance coverage improves. Research shows that patients want to talk about cost with their physicians, but few are actually doing so. The GoodRx survey of American adults found that only 42% were having these conversations. And given that cost is a barrier to filling prescriptions, cost conversations should happen every time medications are prescribed. While some Americans can't afford their medications, 26% can't access their medication at all due to shortages. Among the drugs that people are struggling to access are Ozempic, Trulicity, Zepbound, Mounjaro, Losartan, Adderall, and some antibiotics. Factors contributing to shortages may include increased demand, supply chain issues, and manufacturing delays. The survey was run through YouGov, in three waves. The survey ran monthly from February 2024 through January 2025. In each wave, GoodRx collected 1,000 responses. Survey responses were weighted to the U.S. population using age, gender, race, political affiliation, and education level. The YouGov survey research arm provides more information. To estimate the number of Americans who left a prescription at the pharmacy each month, the survey's incidence rate was multiplied by the percentage of respondents who reported leaving at least one prescription at the pharmacy. This product was then multiplied by the total number of American adults, based on data from the 2019 American Community Survey. This story was produced by GoodRx and reviewed and distributed by Stacker.
Miami Herald
19-05-2025
- Health
- Miami Herald
Nearly a third of Americans aren't filling their prescriptions because of high costs
Healthcare professionals write millions of prescriptions every year to help Americans manage symptoms and treat a range of conditions. But affordability, access issues, and drug shortages prevent people from actually filling these prescriptions. GoodRx Research ran a 12-month survey to better understand the dynamics that shape prescription medication fills and consumer behavior. The following insights come from this survey of nearly 12,000 Americans. The findings highlight the significant financial and accessibility challenges people with and without insurance face in filling their prescriptions. Key takeaways: According to a GoodRx Research survey, 29% of Americans leave prescriptions for medications unfilled due to cost. Cost is a barrier for people with and without insurance. Yet most patients don't talk about medication affordability with their shortages prevent 26% of Americans from accessing their prescribed medications. This includes access to essential medications like Ozempic, insulins, and some prescriptions present serious health risks and long-term healthcare expenses. According to the GoodRx survey, 33% of Americans (52 million if extrapolated to the general population) had a prescription sent to the pharmacy that was ultimately not filled. So why aren't people filling these prescriptions? Medication cost is the main reason. People also forget to pick up their medications. Timing is another big issue. When people do go to the pharmacy, their medication may be out of stock. And many people just can't get to the pharmacy in time. This finding is alarming given that nonadherence, or not taking a medication as prescribed, can worsen chronic conditions. The high cost of medications can force people to make difficult choices between prioritizing their health and managing other essential expenses. In turn, this can lead to poor health outcomes and increased costs in the long run. Medication cost is the leading cause of unfilled prescriptions in the U.S. And this is an issue that affects people with and without health insurance. In fact, nearly a quarter of Americans are unable to fill their medication because their insurance doesn't cover it. When insurance doesn't cover a medication, patients are often on the hook for the full price. They may face financial strain and, ultimately, gaps in treatment and worsening symptoms. As it turns out, individuals who rely on the Affordable Care Act health exchange insurance plans have poorer coverage compared to other plan types. Among those on health exchange plans, 34% report a lack of prescription coverage. People with Tricare, Veterans Affairs (VA) insurance, or other military insurance have the highest rates of prescription coverage. GoodRx Research found that 23% of people spent more than $50 on their prescriptions per month (after removing respondents with Medicaid coverage). And nearly 10% reported spending over $100 on their prescriptions in the most recent month. And, once again, people with a health exchange plan, no insurance, or private insurance seem to pay more out of pocket on their prescriptions each month. Costs vary a lot for people with exchange plans. Only 19.7% pay nothing out of pocket and 2.9% pay $200 or more per month. This group, along with those enrolled in private insurance, appear to have the worst coverage for prescription medications. A substantial portion of their out-of-pocket costs falls into the mid-to-high cost brackets. Medicaid recipients, on the other hand, appear to have the most comprehensive prescription coverage. This finding is a reminder that prescription affordability will remain a barrier to medication adherence concern for many Americans until costs come down or insurance coverage improves. Research shows that patients want to talk about cost with their physicians, but few are actually doing so. The GoodRx survey of American adults found that only 42% were having these conversations. And given that cost is a barrier to filling prescriptions, cost conversations should happen every time medications are prescribed. While some Americans can't afford their medications, 26% can't access their medication at all due to shortages. Among the drugs that people are struggling to access are Ozempic, Trulicity, Zepbound, Mounjaro, Losartan, Adderall, and some antibiotics. Factors contributing to shortages may include increased demand, supply chain issues, and manufacturing delays. Methodology The survey was run through YouGov, in three waves. The survey ran monthly from February 2024 through January 2025. In each wave, GoodRx collected 1,000 responses. Survey responses were weighted to the U.S. population using age, gender, race, political affiliation, and education level. The YouGov survey research arm provides more information. To estimate the number of Americans who left a prescription at the pharmacy each month, the survey's incidence rate was multiplied by the percentage of respondents who reported leaving at least one prescription at the pharmacy. This product was then multiplied by the total number of American adults, based on data from the 2019 American Community Survey. This story was produced by GoodRx and reviewed and distributed by Stacker. © Stacker Media, LLC.
Newsweek
16-05-2025
- Health
- Newsweek
GoodRx CEO: The Rise of the 'Pay-tient' Means We Must Reimagine Health Care Plans
It's time for us to rethink what health insurance looks like in the U.S. I remember a time when having a commercial health plan meant my basic health care needs were covered. I would go to the pharmacy counter, pay the $10 copay, and walk away with my prescription. Now, it's rarely that easy. The Declining State of Health Insurance Coverage It's no secret that health insurance is covering less while simultaneously becoming more complex to navigate. In fact, a new report from GoodRx Research—Coverage With a Catch: The Uneven Landscape of Prescription Coverage and Restrictions Across U.S. Insurance—shows that prescription insurance coverage has become less comprehensive and more restrictive across all insurance types—commercial, Medicare, and Medicaid. A pharmacist is seen taking a drug from a drawer cabinet. A pharmacist is seen taking a drug from a drawer cabinet. Getty Images For the average commercial insurance plan, our research shows 21 percent of medications lack coverage and 35 percent of covered medications have restrictions, meaning these drugs are subject to additional requirements before insurance agrees to pay. For patients on Medicare, coverage is even worse—the average Medicare plan doesn't cover 44 percent of medications and imposes restrictions on nearly half of the medications that are covered. And while the average Medicaid plan covers 97 percent of medications, 63 percent of those medications have restrictions. Across the board, getting through the red tape is often lengthy and complex, potentially leading to delays in treatment and added stress for patients. Understandably, these insurance challenges leave millions of Americans frustrated when trying to fill prescriptions. The bureaucratic obstacles not only exacerbate delays, but often translate to more of the cost burden shifting to the consumer. And consumers don't want to pay more than they feel is fair for their medications, especially when they're already seeing monthly health insurance premiums increase, taking more from their paychecks. Beyond the price factor, they also don't want to spend their free time jumping through hurdles to access medications. What used to be a quick trip to the pharmacy now requires cost-conscious consumers to price shop and find affordability options ahead of time due to the complex nature of navigating health plans. Faced with these challenges, an increasing number of Americans are turning to cash pay, meaning they are paying for their medications out-of-pocket, to bypass the often time-consuming insurance processes. The Rise of the "Pay-tient" Ten years ago, consumers didn't even know what "cash pay" meant—there was no need for it. Now, millions of Americans are reliant upon it. We must find ways to make cash prices more accessible and we can start by reimagining what health plans look like. The next-generation of health insurance needs to be fully integrated—cash prices and funded prices should be ubiquitous. Let's look at what that means in practice. When a consumer goes to the pharmacy counter, they shouldn't have to worry about whether a drug is covered under their insurance plan. Drugs not covered by insurance should automatically have a low cash price attached to them, and drugs that are covered but still have high price tags or restrictions should show the consumer the cash price if it's lower than the copay. Under this model, it makes no difference to a consumer whether they're using their insurance benefit or not, as the charge hitting their credit card will be the lowest possible. GoodRx has already started doing this with covered generics through its Integrated Savings Programs, automatically giving consumers the lowest available price at the pharmacy counter and applying it toward their deductible. We are working to integrate off-benefit and brand-name medications as well. Reengineering Health Plans One of the driving forces behind shrinking coverage is that employers simply can't afford to cover everything. Add on inflation, the threat of tariffs, and rising health care costs, and it's very unlikely that this trend will reverse in the foreseeable future. But there's more employers can do if they think outside the traditional bounds of health insurance plans to ensure their employees have an easy pathway to accessing medications that aren't covered. This is where reengineering health plans comes in. Implementing an integrated system would drive better value for consumers and employers, while also supporting the interests of health care professionals, retail pharmacies, pharmaceutical manufacturers, and many other stakeholders in the prescription ecosystem. Beyond giving consumers the best price, regardless of insurance coverage, this shift will free up health care professionals who are bogged down with prior authorizations and paperwork, giving them more time and energy to focus on the right treatment plan for each patient. It also supports the profitability of retail pharmacies, helping overcome the epidemic of abandoned prescriptions when patients walk away due to cost. And pharmaceutical manufacturers can get more patients to start and stay on brand-name therapies, rather than lose these consumers to alternative treatments when their insurance plans won't cover the medication. The U.S. health care system is notoriously complex, and changes won't happen overnight. But to address high health care costs and keep people adherent to their prescribed treatment plans, it's critical that we evolve our current system to bring fair prices to all Americans—without the extra legwork. Wendy Barnes is president and CEO of GoodRx. The views expressed in this article are the writer's own.
Yahoo
04-03-2025
- Health
- Yahoo
The crisis over GLP-1 out-of-pocket costs deepens—it's time for health-care leaders to step up
Health-care professionals, eager to support their patients diagnosed with diabetes or obesity, are writing more prescriptions for these life-changing medications. In 2024 alone, prescription fills for FDA-approved weight loss medications Zepbound and Wegovy more than doubled. And with studies predicting staggering increases in the obesity rate by 2050, and the multiple conditions these drugs could help, interest in GLP-1s will continue to grow. Unfortunately, cost is still prohibiting many Americans from accessing these medications. Despite the proven efficacy and external pressures, a new report from GoodRx Research found that commercial insurance coverage has not improved across the board in 2025. For example, the number of people without any commercial insurance coverage for Zepbound increased by over 14% in 2025. Even with increased coverage for Wegovy in 2025, 83% of people with coverage still face restrictions like prior authorization or step therapy, whether they're prescribed the medication for obesity, cardiovascular disease, or any other indication. And employers, saddled with the impact of inflation and rising health-care costs, don't want to foot the bill. While there are long-term health benefits and related savings for people taking GLP-1s, most employers and health plans that paid for the upfront costs don't actually benefit when people change jobs every four years. But the burden doesn't all fall on insurance plans and employers. Pharmaceutical manufacturers have set high list prices, citing among other things overwhelming demand, supply shortages, the cost of innovation, additional competitors joining the market, and anticipated price negotiations with the government as part of the Inflation Reduction Act (IRA). These prices have made it even more cost-prohibitive for insurance companies and employers to keep GIP and GLP-1 medications on their plans. To alleviate the high costs affecting consumers, health-care leaders need to come to the table to address the friction preventing greater access and affordability. Everyone has a role to play. Pharmaceutical manufacturers must reevaluate the list price and implement more affordability programs to help consumers prescribed GIP and GLP-1 medications for obesity. Eli Lilly took a step in the right direction recently by lowering the price of single-dose Zepbound vials by about $50. But there is still a greater need for more widely available cash price options at retail pharmacies across the country. These days, more consumers—frustrated with the friction and inefficiencies in the health-care system—opt for cash pay solutions so they can get the medications they need quickly and easily. Manufacturers should also take the reins and spearhead industry-wide conversations on the long-term economic and clinical benefits of obesity treatment. The current perspective is too narrowly focused on short-term costs, overlooking the impact that improved population health has on patient outcomes and overall health-care spending. Employers and health plans must then make better efforts to minimize restrictions on GIP and GLP-1 coverage. GoodRx Research shows restrictions limit over 82% of insurance coverage for Wegovy, Zepbound, and Saxenda when prescribed for weight loss. Even when GIP and GLP-1 agonists are prescribed for Type 2 diabetes, additional restrictions are usually placed on commercial insurance coverage—over 75% of the time for Mounjaro and over 83% of the time for Ozempic. And the government needs to intervene, requiring Medicare to treat obesity as a chronic condition and initiating coverage for Part D enrollees who are prescribed a GIP or GLP-1 medication solely for the treatment of weight loss, rather than restricting coverage to those with diabetes or cardiovascular disease. A shift like this would trickle down to improvements in commercial insurance coverage, placing pressure on other payers and potentially stimulating a reevaluation of coverage and restrictions across the board. It's time to come together to solve the GIP and GLP-1 challenge. As health-care leaders, it's our responsibility to step up and innovate to bridge access and affordability gaps. By making a commitment to affordability and opening the door to greater collaboration to reduce out-of-pocket medication spending, we can ensure that more people are able to reap the health benefits of these critical medications. The opinions expressed in commentary pieces are solely the views of their authors and do not necessarily reflect the opinions and beliefs of Fortune. Read more: I'm an obesity medicine doctor and I've been on weight-loss drugs like Ozempic for a decade. Here's why I think they aren't a fad Here's the real reason Ozempic-like weight-loss drugs are so popular Ozempic and Wegovy are trimming waistlines—and showing how quickly U.S. health care can turn into a gold rush This story was originally featured on
