RESEARCH STARTER

Unaffordable medication

Unaffordable medications refer to prescription drugs that impose excessively high out-of-pocket costs on patients, making them financially inaccessible even with insurance coverage. This issue is prevalent in the United States, where drug prices are generally higher than in other countries due to various factors, including patent laws and the significant costs associated with research and development. Many individuals face dilemmas when it comes to affording necessary medications, particularly for serious health conditions, leading to concerns about healthcare equity. Drugs like insulin and those used for chronic conditions such as rheumatoid arthritis can cost thousands of dollars monthly, often exacerbated by stringent insurance requirements and rising prices. Patients with limited income or multiple prescriptions find it particularly challenging to manage these costs. Experts suggest consulting healthcare providers for alternatives or assistance, exploring pharmacy options, and researching patient assistance programs to mitigate the financial burden. The ongoing dialogue around drug pricing underscores the need for systemic changes to ensure equitable access to essential medications.

Full Article

Medications that are considered unaffordable are any prescription drugs that have an unreasonably high out-of-pocket cost for the patient. Some medications are unaffordable because the price from the manufacturer is very high, and the product is not covered by insurance. Others are unaffordable even with insurance coverage, as the amount the patient has to pay is very high. Medications are also unaffordable when the out-of-pocket cost is out of reach for a patient because they have limited income and/or are taking and paying for multiple prescriptions.

Experts say that prescription drugs, on average, are more expensive in the United States than elsewhere. This is in part because of differences in laws governing drug pricing. Unaffordable medications are a problem because they leave people with limited options for meeting health needs. The issue also raises questions of equity in health care because people with lower incomes may not receive the same level of care as others.

Background

A number of factors affect prescription drug prices. The cost and availability of raw materials are factors, as are special procedures or equipment needed for the manufacture, shipment, or storage of the medication. Another factor is the research and development (R&D) costs incurred by the company that creates the drug. Costs for developing, testing, and bringing a drug to market are in the millions, with some studies showing average costs from hundreds of millions to several billion dollars. Drug companies consider R&D costs and set a price based on recovering those funds. Some experts also use measures such as Quality-Adjusted Life Years (QALYs) to evaluate whether a drug provides good value for its cost.

When new drugs are marketed, they are usually covered by a government patent and given a brand name. This means that only the company that created the drug can sell it in any form for a set period of time. In the United States, patents generally last twenty years from the date they are filed. This allows the company time to sell the drug to recover its costs without competition. Some drugs are also given exclusivity, which is another limitation on who can make similar drugs. After these expire, other companies can make versions of the original drug. These are usually referred to as generic drugs, or, in the case of biologic drugs, biosimilars. Generally speaking, they have the same active ingredients as the brand name drug, but may have different inactive ingredients that make up the pill, tablet, etc.

Industry experts note that drug prices climbed noticeably beginning in the 1990s. They attribute this to several factors. One was the development of new technology, including the use of biologics, or pharmaceuticals that are made using living cells or organisms. Another was the laws that allowed drug companies to advertise directly to consumers. This led people to directly request the newest drugs instead of relying on their physician to recommend products.

Overview

Many of the most expensive drugs—those costing tens of thousands of dollars per month—are for less common but often life-threatening conditions, including some cancers and blood diseases, making them unaffordable for many patients. These are often what people think about when unaffordable drugs are mentioned.

There are many other drugs that are used for more common conditions that can also be unaffordable. For example, in the early 2020s, Humira, used to treat Crohn’s disease and rheumatoid arthritis, and Enbrel, also used for rheumatoid arthritis, cost $9,000 or more per month. Cosentyx and Otezla, used for psoriasis, ranged between $6,000 and nearly $9,000 per month. These drugs are often subjected to special insurance rules such as prior authorization and higher copays that can make them difficult or impossible for patients to afford. According to information published by KFF (Kaiser Family Foundation) in 2024 and 2026, about one-quarter of American adults have difficulty affording prescription drugs, and six in ten worry about being able to afford them. High-cost GLP-1 drugs such as Ozempic and Wegovy also became major examples of affordability concerns for common conditions, and many adults said these drugs were difficult to afford.

Another reason for unaffordable medications is skyrocketing prescription costs. For instance, research has indicated that the price for insulin—a life-sustaining drug for the treatment of diabetes—increased significantly between 2014 and 2019. Several reasons contributed to the cost increases, but the main one is similar to the reasons that drug prices overall have increased. New methods of making the drugs have replaced older ways, and these usually come with higher costs. After people with diabetes and their advocates raised concerns about increasing prices, manufacturers and the government took steps to begin decreasing costs. Federal policy also lowered some Medicare costs by capping the monthly cost of covered insulin at $35 and by establishing negotiated prices for selected high-cost drugs. The same law also redesigned Medicare Part D, creating a new annual out-of-pocket cap of $2,000 in 2025, which rose to $2,100 in 2026. These changes have provided important relief for some Medicare enrollees, but they do not eliminate affordability problems for everyone, especially people with private insurance, the uninsured, or those using drugs that remain expensive even after insurance coverage.

All these factors—supply and R&D costs, regulations, new technology, reduced competition due to patent rules, etc.—contribute to unaffordable medications. However, some experts say that it is really drug company policies and decisions that have the biggest impact on medication prices. They claim that drug companies charge what they think the market will bear. That means that a new drug for a condition like psoriasis, which can make people both physically and emotionally uncomfortable, might be priced higher just because they think a lot of people will be willing to pay more for a new treatment option. Drug companies also often raise the price of existing products when new ones are released as a way of minimizing the discrepancy between the prices. They also use a technique called evergreening to adjust the formula for an existing product just enough to qualify for a new patent as a previous patent expires.

Experts also point to the fact that many drugs are significantly more expensive in the United States than in other countries. This is largely because other countries have laws in place that place limits on drug costs, while the United States has fewer such laws. Consumer advocates say that laws that would allow the government to cap the costs of new drugs, regulate price increases, and negotiate the prices of some Medicare drugs could help reduce the number of unaffordable medications.

Options

Experts say that people who are faced with unattainably high out-of-pocket expenses for prescription drugs should start by talking to their doctor. They should do this before resorting to other options such as cutting pills, skipping doses, or not taking the medication at all. In some cases, a less expensive alternative may be available or the physician may be able to appeal to an insurer to cover a medication.

Another option is to consult with a pharmacist who might also be able to recommend alternatives to discuss with a physician. Both physicians and pharmacists may be able to help with information about programs such as copay cards that help pay for expensive drugs or assist with out-of-pocket costs. Shopping around to different pharmacies can also help, as drug prices have been found to vary widely in different locations and between chain stores and independent pharmacies. The companies that make some high-cost drugs offer their own programs as well, so contacting the company may provide help.

Researching options online is another possible way to reduce medication costs. For example, in some cases, drugs are available in multiple forms. While the drug taken at home may be too expensive, a form that is administered in a medical facility may be covered at a lower out-of-pocket cost.


Bibliography

Baumrucker, Evelyne P et al. “Health Care Provisions of the Budget Reconciliation Measure P.L. 117-169.” Congress.gov, 24 Jan. 2023, crsreports.congress.gov/product/pdf/R/R47396. Accessed 14 Apr. 2026.

“Biosimilars.” U.S. Food and Drug Administration, 1 Mar. 2023, fda.gov/drugs/therapeutic-biologics-applications-bla/biosimilars. Accessed 14 Apr. 2026.

“Budgetary Effects of Policies to Modify or Eliminate Medicaid’s Institutions for Mental Diseases Exclusion.” Congressional Budget Office, 13 Apr. 2023, cbo.gov/publication/58962. Accessed 14 Apr. 2026.

“Comparing Prescription Drugs in the U.S. and Other Countries: Prices and Availability.” Office of the Assistant Secretary for Planning and Evaluation. 31 Jan. 2024, aspe.hhs.gov/reports/comparing-prescription-drugs. Accessed 14 Apr. 2026.

Cubanski, Juliette, and Anthony Damico. “Insulin Out-of-Pocket Costs in Medicare Part D.” KFF, 28 July 2022, kff.org/medicare/insulin-out-of-pocket-costs-in-medicare-part-d/. Accessed 14 Apr. 2026.

DiMasi, Joseph A., et al. “Innovation in the Pharmaceutical Industry: New Estimates of R&D Costs.” Journal of Health Economics, vol. 47, 2016, pp. 20–33, doi:10.1016/j.jhealeco.2016.01.012. Accessed 14 Apr. 2026.

“Frequently Asked Questions on Patents and Exclusivity.” U.S. Food & Drug Administration, 5 Feb. 2020, www.fda.gov/drugs/development-approval-process-drugs/frequently-asked-questions-patents-and-exclusivity. Accessed 14 Apr. 2026.

Kearney, Audrey, et al. “Public Opinion on Prescription Drugs and Their Prices.” KFF, 31 Mar. 2026, kff.org/health-costs/public-opinion-on-prescription-drugs-and-their-prices/. Accessed 14 Apr. 2026.

Kesselheim, Aaron S., et al. “The High Cost of Prescription Drugs in the United States: Origins and Prospects for Reform.” JAMA, vol. 316, no. 8, Aug. 2016, pp. 858–71. doi:10.1001/jama.2016.11237. Accessed 14 Apr. 2026.

Kolata, Gina, and Francesca Paris. “The Medicine is a Miracle, but Only if You Can Afford it.” The New York Times, 7 Feb. 2023, www.nytimes.com/2023/02/07/health/medicine-insurance-payments.html. Accessed 14 Apr. 2026.

LaFee, Scott, and Nicole Mlynaryk. “Why Are Prescription Drugs So Expensive? It’s Not Necessarily High R&D, New Study Shows.” University of California, 29 Sept. 2022, www.universityofcalifornia.edu/news/why-are-prescription-drugs-so-expensive-its-not-necessarily-high-rd-new-study-shows. Accessed 14 Apr. 2026.

“Making Medicines Affordable: A National Imperative.” National Library of Medicine, www.ncbi.nlm.nih.gov/books/NBK493090/. Accessed 14 Apr. 2026.

“Poll: 1 in 8 Adults Say They Are Currently Taking a GLP-1 Drug for Weight Loss, Diabetes or Another Condition, Even as Half Say the Drugs Are Difficult to Afford.” KFF, 14 Nov. 2025, kff.org/public-opinion/poll-1-in-8-adults-say-they-are-currently-taking-a-glp-1-drug-for-weight-loss-diabetes-or-another-condition-even-as-half-say-the-drugs-are-difficult-to-afford/. Accessed 14 Apr. 2026.

“Purple Book: Database of Licensed Biological Products.” U.S. Food and Drug Administration, purplebooksearch.fda.gov/. Accessed 14 Apr. 2026.

Smith, Camilo Hannibal. “Why Are Prescription Drugs More Expensive in the U.S. Than in Other Countries?” GoodRx, 19 Oct. 2022, www.goodrx.com/healthcare-access/drug-cost-and-savings/why-are-prescription-drugs-more-expensive-in-the-us-than-in-other-countries. Accessed 14 Apr. 2026.

Wells, Anna. “The Top 10 Most Expensive Popular Brand-Name Drugs in the U.S. (and How to Save).” GoodRx, 14 July 2021, www.goodrx.com/healthcare-access/drug-cost-and-savings/top-10-most-expensive-popular-brand-name-drugs-us-how-to-save. Accessed 14 Apr. 2026.

“What You can do if You Can’t Afford Your Medication.” Norton Healthcare, 15 June. 2022, nortonhealthcare.com/news/cant-afford-medication/. Accessed 14 Apr. 2026.

Full Article

Medications that are considered unaffordable are any prescription drugs that have an unreasonably high out-of-pocket cost for the patient. Some medications are unaffordable because the price from the manufacturer is very high, and the product is not covered by insurance. Others are unaffordable even with insurance coverage, as the amount the patient has to pay is very high. Medications are also unaffordable when the out-of-pocket cost is out of reach for a patient because they have limited income and/or are taking and paying for multiple prescriptions.

Experts say that prescription drugs, on average, are more expensive in the United States than elsewhere. This is in part because of differences in laws governing drug pricing. Unaffordable medications are a problem because they leave people with limited options for meeting health needs. The issue also raises questions of equity in health care because people with lower incomes may not receive the same level of care as others.

Background

A number of factors affect prescription drug prices. The cost and availability of raw materials are factors, as are special procedures or equipment needed for the manufacture, shipment, or storage of the medication. Another factor is the research and development (R&D) costs incurred by the company that creates the drug. Costs for developing, testing, and bringing a drug to market are in the millions, with some studies showing average costs from hundreds of millions to several billion dollars. Drug companies consider R&D costs and set a price based on recovering those funds. Some experts also use measures such as Quality-Adjusted Life Years (QALYs) to evaluate whether a drug provides good value for its cost.

When new drugs are marketed, they are usually covered by a government patent and given a brand name. This means that only the company that created the drug can sell it in any form for a set period of time. In the United States, patents generally last twenty years from the date they are filed. This allows the company time to sell the drug to recover its costs without competition. Some drugs are also given exclusivity, which is another limitation on who can make similar drugs. After these expire, other companies can make versions of the original drug. These are usually referred to as generic drugs, or, in the case of biologic drugs, biosimilars. Generally speaking, they have the same active ingredients as the brand name drug, but may have different inactive ingredients that make up the pill, tablet, etc.

Industry experts note that drug prices climbed noticeably beginning in the 1990s. They attribute this to several factors. One was the development of new technology, including the use of biologics, or pharmaceuticals that are made using living cells or organisms. Another was the laws that allowed drug companies to advertise directly to consumers. This led people to directly request the newest drugs instead of relying on their physician to recommend products.

Overview

Many of the most expensive drugs—those costing tens of thousands of dollars per month—are for less common but often life-threatening conditions, including some cancers and blood diseases, making them unaffordable for many patients. These are often what people think about when unaffordable drugs are mentioned.

There are many other drugs that are used for more common conditions that can also be unaffordable. For example, in the early 2020s, Humira, used to treat Crohn’s disease and rheumatoid arthritis, and Enbrel, also used for rheumatoid arthritis, cost $9,000 or more per month. Cosentyx and Otezla, used for psoriasis, ranged between $6,000 and nearly $9,000 per month. These drugs are often subjected to special insurance rules such as prior authorization and higher copays that can make them difficult or impossible for patients to afford. According to information published by KFF (Kaiser Family Foundation) in 2024 and 2026, about one-quarter of American adults have difficulty affording prescription drugs, and six in ten worry about being able to afford them. High-cost GLP-1 drugs such as Ozempic and Wegovy also became major examples of affordability concerns for common conditions, and many adults said these drugs were difficult to afford.

Another reason for unaffordable medications is skyrocketing prescription costs. For instance, research has indicated that the price for insulin—a life-sustaining drug for the treatment of diabetes—increased significantly between 2014 and 2019. Several reasons contributed to the cost increases, but the main one is similar to the reasons that drug prices overall have increased. New methods of making the drugs have replaced older ways, and these usually come with higher costs. After people with diabetes and their advocates raised concerns about increasing prices, manufacturers and the government took steps to begin decreasing costs. Federal policy also lowered some Medicare costs by capping the monthly cost of covered insulin at $35 and by establishing negotiated prices for selected high-cost drugs. The same law also redesigned Medicare Part D, creating a new annual out-of-pocket cap of $2,000 in 2025, which rose to $2,100 in 2026. These changes have provided important relief for some Medicare enrollees, but they do not eliminate affordability problems for everyone, especially people with private insurance, the uninsured, or those using drugs that remain expensive even after insurance coverage.

All these factors—supply and R&D costs, regulations, new technology, reduced competition due to patent rules, etc.—contribute to unaffordable medications. However, some experts say that it is really drug company policies and decisions that have the biggest impact on medication prices. They claim that drug companies charge what they think the market will bear. That means that a new drug for a condition like psoriasis, which can make people both physically and emotionally uncomfortable, might be priced higher just because they think a lot of people will be willing to pay more for a new treatment option. Drug companies also often raise the price of existing products when new ones are released as a way of minimizing the discrepancy between the prices. They also use a technique called evergreening to adjust the formula for an existing product just enough to qualify for a new patent as a previous patent expires.

Experts also point to the fact that many drugs are significantly more expensive in the United States than in other countries. This is largely because other countries have laws in place that place limits on drug costs, while the United States has fewer such laws. Consumer advocates say that laws that would allow the government to cap the costs of new drugs, regulate price increases, and negotiate the prices of some Medicare drugs could help reduce the number of unaffordable medications.

Options

Experts say that people who are faced with unattainably high out-of-pocket expenses for prescription drugs should start by talking to their doctor. They should do this before resorting to other options such as cutting pills, skipping doses, or not taking the medication at all. In some cases, a less expensive alternative may be available or the physician may be able to appeal to an insurer to cover a medication.

Another option is to consult with a pharmacist who might also be able to recommend alternatives to discuss with a physician. Both physicians and pharmacists may be able to help with information about programs such as copay cards that help pay for expensive drugs or assist with out-of-pocket costs. Shopping around to different pharmacies can also help, as drug prices have been found to vary widely in different locations and between chain stores and independent pharmacies. The companies that make some high-cost drugs offer their own programs as well, so contacting the company may provide help.

Researching options online is another possible way to reduce medication costs. For example, in some cases, drugs are available in multiple forms. While the drug taken at home may be too expensive, a form that is administered in a medical facility may be covered at a lower out-of-pocket cost.


Bibliography

Baumrucker, Evelyne P et al. “Health Care Provisions of the Budget Reconciliation Measure P.L. 117-169.” Congress.gov, 24 Jan. 2023, crsreports.congress.gov/product/pdf/R/R47396. Accessed 14 Apr. 2026.

“Biosimilars.” U.S. Food and Drug Administration, 1 Mar. 2023, fda.gov/drugs/therapeutic-biologics-applications-bla/biosimilars. Accessed 14 Apr. 2026.

“Budgetary Effects of Policies to Modify or Eliminate Medicaid’s Institutions for Mental Diseases Exclusion.” Congressional Budget Office, 13 Apr. 2023, cbo.gov/publication/58962. Accessed 14 Apr. 2026.

“Comparing Prescription Drugs in the U.S. and Other Countries: Prices and Availability.” Office of the Assistant Secretary for Planning and Evaluation. 31 Jan. 2024, aspe.hhs.gov/reports/comparing-prescription-drugs. Accessed 14 Apr. 2026.

Cubanski, Juliette, and Anthony Damico. “Insulin Out-of-Pocket Costs in Medicare Part D.” KFF, 28 July 2022, kff.org/medicare/insulin-out-of-pocket-costs-in-medicare-part-d/. Accessed 14 Apr. 2026.

DiMasi, Joseph A., et al. “Innovation in the Pharmaceutical Industry: New Estimates of R&D Costs.” Journal of Health Economics, vol. 47, 2016, pp. 20–33, doi:10.1016/j.jhealeco.2016.01.012. Accessed 14 Apr. 2026.

“Frequently Asked Questions on Patents and Exclusivity.” U.S. Food & Drug Administration, 5 Feb. 2020, www.fda.gov/drugs/development-approval-process-drugs/frequently-asked-questions-patents-and-exclusivity. Accessed 14 Apr. 2026.

Kearney, Audrey, et al. “Public Opinion on Prescription Drugs and Their Prices.” KFF, 31 Mar. 2026, kff.org/health-costs/public-opinion-on-prescription-drugs-and-their-prices/. Accessed 14 Apr. 2026.

Kesselheim, Aaron S., et al. “The High Cost of Prescription Drugs in the United States: Origins and Prospects for Reform.” JAMA, vol. 316, no. 8, Aug. 2016, pp. 858–71. doi:10.1001/jama.2016.11237. Accessed 14 Apr. 2026.

Kolata, Gina, and Francesca Paris. “The Medicine is a Miracle, but Only if You Can Afford it.” The New York Times, 7 Feb. 2023, www.nytimes.com/2023/02/07/health/medicine-insurance-payments.html. Accessed 14 Apr. 2026.

LaFee, Scott, and Nicole Mlynaryk. “Why Are Prescription Drugs So Expensive? It’s Not Necessarily High R&D, New Study Shows.” University of California, 29 Sept. 2022, www.universityofcalifornia.edu/news/why-are-prescription-drugs-so-expensive-its-not-necessarily-high-rd-new-study-shows. Accessed 14 Apr. 2026.

“Making Medicines Affordable: A National Imperative.” National Library of Medicine, www.ncbi.nlm.nih.gov/books/NBK493090/. Accessed 14 Apr. 2026.

“Poll: 1 in 8 Adults Say They Are Currently Taking a GLP-1 Drug for Weight Loss, Diabetes or Another Condition, Even as Half Say the Drugs Are Difficult to Afford.” KFF, 14 Nov. 2025, kff.org/public-opinion/poll-1-in-8-adults-say-they-are-currently-taking-a-glp-1-drug-for-weight-loss-diabetes-or-another-condition-even-as-half-say-the-drugs-are-difficult-to-afford/. Accessed 14 Apr. 2026.

“Purple Book: Database of Licensed Biological Products.” U.S. Food and Drug Administration, purplebooksearch.fda.gov/. Accessed 14 Apr. 2026.

Smith, Camilo Hannibal. “Why Are Prescription Drugs More Expensive in the U.S. Than in Other Countries?” GoodRx, 19 Oct. 2022, www.goodrx.com/healthcare-access/drug-cost-and-savings/why-are-prescription-drugs-more-expensive-in-the-us-than-in-other-countries. Accessed 14 Apr. 2026.

Wells, Anna. “The Top 10 Most Expensive Popular Brand-Name Drugs in the U.S. (and How to Save).” GoodRx, 14 July 2021, www.goodrx.com/healthcare-access/drug-cost-and-savings/top-10-most-expensive-popular-brand-name-drugs-us-how-to-save. Accessed 14 Apr. 2026.

“What You can do if You Can’t Afford Your Medication.” Norton Healthcare, 15 June. 2022, nortonhealthcare.com/news/cant-afford-medication/. Accessed 14 Apr. 2026.

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