In the Years Before the COVID-19 Pandemic, Nearly 13 Million Adults Delayed or Did Not Get Needed Prescription Drugs Because of Costs

Finding from the 2018–2019 Medical Expenditure Panel Survey

A nurse shows a patient how to use a pill box.

An analysis of the challenges many faced affording prescription drugs in the years before the COVID-19 outbreak finds high costs prevented or delayed nearly 13 million adults from accessing needed medications.

The Issue

The United States has a history of drug unaffordability and inaccessibility, especially for older adults living in underserved communities, and more than two million Medicare beneficiaries and nearly four million privately insured working-age adults reported skipping needed treatment because of cost.  

Key Findings

The analysis from the Urban Institute offers insight as Congress debates drug pricing reform provisions in the Build Back Better Acts, discovering:

  • More than one-quarter of adults with Medicare (25.4%) and 5.3% of privately insured adults spent more than 1% of their family income on their individual out-of-pocket prescription drug costs. More than 3% of Medicare beneficiaries—and nearly 7% of beneficiaries with unmet prescription drug needs—spent over more than 10% of their family income on prescription drugs.  

  • About one-in-ten adults who were uninsured all year (9.5%) or part of the year (11.6%) reported unmet prescription drug needs, compared with 4.9% of Medicare beneficiaries, 3.0% of privately insured adults, and 5.6% of nonelderly adults with Medicaid.  

  • For Medicare beneficiaries and privately insured adults, unmet prescription drug needs were most common among women, people with low incomes, and people with multiple chronic health conditions.


High and rising prescription drug costs are a considerable public health concern that fosters accessibility challenges and unmet needs for consumers, regardless of coverage status. Policies to reduce drug prices, limit out-of-pocket costs and expand health insurance coverage would help millions afford and access needed prescription they are currently unable to pay for.

About the Urban Institute

The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. Visit the Urban Institute’s Health Policy Center for more information specific to its staff and its recent research.