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The Cost of Not Taking Your Medicine

“Approximately 50% of medications for chronic illness are not taken as prescribed,” according to a New York Times article I read a few months ago. In the article, “The Cost of Not Taking Your Medicine,” a health “epidemic” affecting “more people than any disease” is sweeping across the United States right now: nonadherence to prescribed medication.

What is “nonadherence” exactly?

Medication nonadherence basically means not taking your medicine (at all) or not taking it as prescribed by your physician(s) or not following physician’s orders for treatment. According to a review in Annals of Internal Medicine, mentioned in the New York Times article,

“Studies have consistently shown that 20 percent to 30 percent of medication prescriptions are never filled. People who do take prescription medications — whether it’s for a simple infection or a life-threatening condition — typically take only about half the prescribed doses.”

Wow, these are kind of shocking numbers; I never realized that nonadherence was so prevalent and such a problem. My personal medication-taking habits differ greatly, for the most part, from the non-adherent patients described in the article. I feel a bit embarrassed that I had no idea about this issue.

Here are some more shocking numbers if the first ones didn’t get your attention. According to the Annals’ review, this lack of adherence is estimated to cause approximately 125,000 deaths and at least 10 percent of hospitalizations, and to cost the American health care system between $100 billion and $289 billion a year.

Billions of dollars a year?! OK, yes, this is a huge problem. Why aren’t people taking their medications? Don’t they want to get better? There are no simple answers to these questions, of course. Several reasons can explain why people don’t take their medications as prescribed or at all, including: cost, side effects, forgetfulness, emotional reasons, preference for “natural” remedies, lack of symptoms, confusing medication directions.

Nonadherence and RA

Cost is a big issue when it comes to nonadherence and RA, especially if patients are prescribed any of the insanely expensive biologic medications. Biologic drugs can cost around $4,000 a month (or more), and many people have trouble paying due to high insurance deductibles, copays, and coinsurance. Luckily, most if not all of the pharmaceutical companies have financial assistance programs for the biologic drugs–if you qualify. But I’ve heard from several people about how they can’t afford their RA medication or office visits (and lab work, etc.) so they go without proper treatment.

Personally, I’ve always strictly adhered to taking my RA medication, all medication, the correct way and according to how it’s prescribed since I was diagnosed. I often joke about being a self-diagnosed hypochrondriac, but I do take my health very seriously and often have a lot of anxiety about it. The intense pain and disability (and possible disfiguration) that comes with RA also scares me too much to not stay on top of the disease and my health care the best I can.

I am pro-treatment for RA

As a result of my pro-treatment attitude, I’ve fallen into a very deep, black hole of medical debt, accumulated from years of expensive drugs, office visits, blood work, and other RA costs. However, even though being in debt is incredibly stressful and demoralizing, I would much rather have my RA stable than being disabled by it because of lack of proper care.

Speaking of attitude, I think emotional reasons for not taking RA medication affect a lot of people who have the disease. Choking down several different pills each day gets to be a big burden. Seeing your pills piled up in your hand or lined up on the kitchen counter every morning is also a constant reminder that you’re sick and that something is wrong with you. Nobody wants to be reminded of that, of course.

Whether it’s cost, emotional reasons, forgetfulness, side effects, or anything else that makes people not take their RA medication as directed, nonadherence is happening everywhere and is causing patients and the healthcare system more harm in the long-run. The New York Times article offers some suggestions about how to help people get better at taking their medication:

  1. Use your smartphone to set reminders to take your medication doses,
  2. Try using a “buddy system” to help encourage yourself and a friend to stay on top of things,
  3. Put your prescription bottles in a convenient place that’s easy for you to see and access each day.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.


  • Annette
    2 years ago

    I’m thinking of the times I get a prescription for antibiotics, in case my infection does not improve, just to save an extra trip to see the doctor, I wonder if those are in the noncompliance figures.
    And I have often heard patients talk about postponing methotrexate because of a family event or wedding or an illness – and this might well count in the strictest sense, as non compliance. Really I feel that this is really intelligent self interest and a very sensible adjustment to dealing with a long term chronic illness.

    That point of view is very top down, not with the patient voice being included in the definition of non compliance and non adherence.

  • Richard Faust moderator
    2 years ago

    Hi Annette. You raise some very interesting points. As a researcher, I was trained to look for unaccounted/controlled for variables and alternative hypotheses and several items jump to mind when it comes to the overall non-compliance numbers. People are sometimes given a prescription and told to fill it if a problem continues or they still have medication left when a treatment is changed (this is a common one for conditions like RA) – and these are just a couple. These issues, of course, only account for a percentage of the non-compliance and do not diminish the seriousness and life-threatening aspects of this issue, but to properly report the seriousness the uncontrolled for, but non-conclusion altering variables should be mentioned. Thanks for being a member of the community. Best, Richard ( Team)

  • Lawrence 'rick' Phillips
    2 years ago

    I am also pro treatment. But I am also pro appropriate treatment. When I hear nonadherence I think noncompliant. Noncompliant is one of the worst things I hear as a patient. For me, compliance is a two lane highway. One lane requires the patient to do what is required. The other lane depends on the health care provider knowing their patient and helping them be adherent or compliant.

  • Angela Lundberg author
    2 years ago

    I agree. Well said, Rick! 🙂

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