Every month Jodi Smith has to make some tough choices about which prescription drugs she can afford and which she and her family will have to do without.

The 42-year-old teacher from eastern Michigan and her daughter need pricey asthma inhalers and allergy drugs. But if they both renewed their prescriptions, “we could spend anywhere between $800 and $1,200,” Smith says. And that would quickly break the budget, sending the family spiraling into debt.

So Smith says she has to be “strategic” in how she manages her expenses: “At this time, I am skipping doses to try to pay other bills like our mortgage.”

Making these kinds of difficult and, at times, potentially harmful choices, has become all too common, according to a new nationally representative Consumer Reports survey of 1,200 adults who currently take prescription medications. In the past year, 22 percent of them—which comes to an estimated 27 million Americans—experienced a price hike for one or more of their medications. About a third of those people said they paid at least $50 per month extra for one or more prescriptions.  

More on Drug Costs

When drug costs rise, consumers often resort to desperate measures, our survey suggests. People who experienced price spikes in their meds were more likely to say that, like Smith, they rationed their own meds by not taking them as often as they should. They were also more likely to split their pills without first talking with a doctor, or to use expired medication. And a shocking number—about 20 percent—said they didn’t fill their prescription at all.

People who saw drug price increases were also more likely to make tough financial choices and, in some cases, even delay retirement to maintain their healthcare coverage. For example, a 48-year-old Atlanta woman in our survey, who said her drug prices rose after her employer switched insurers, said she compensated by spending less on groceries and her family. And a 73-year-old woman from Lewiston, Idaho, who blamed drug companies that “just want higher prices,” said she cut back on groceries and put more on her credit card.

“Seeing a patient give up needed medication or not be able to pay for food or housing because of high drug costs is devastating,” says Marvin M. Lipman, M.D., Consumer Reports’ chief medical adviser. “And while it’s not always possible to limit those costs, it often is.”

Here’s how high drug costs are harming Americans’ health and pinching their budgets—plus, our recommendations about what you can do about it:

High Costs, High Risks

Rising drug costs pose special challenges because, unlike many other expenses, drugs usually aren’t optional purchases.

“When the price of airline tickets goes up by $50 or $500, consumers typically choose alternate routes or dates, or put up with driving instead,” says Jing Luo, M.D., a researcher at Harvard Medical School who focuses on prescription drug pricing. But “when the price of a lifesaving or life-prolonging medication goes up, a great many consumers have no choice but to pay the higher prices.”

Maybe that’s why a third of the people in our survey who experienced a drug price hike in the past 12 months said that they responded by simply paying up.

And because drugs are often so essential, when prices rise it often “affects people’s lives in dramatic ways,” says Stephen W. Schondelmeyer, Ph.D., a professor of pharmaceutical economics at the University of Minnesota.

Our survey backs that up—as shown in the chart below.  

As Drug Prices Rise, Quality of Life Goes Down

The high cost of drugs is forcing many Americans to cut back on groceries, delay retirement, or ration their own healthcare in potentially dangerous ways, a CR survey of nearly 1,200 American adults currently taking prescription drugs has found.

As Drug Prices Rise, Quality of Life Goes Down

The high cost of drugs is forcing many Americans to cut back on groceries, delay retirement, or ration their own healthcare in potentially dangerous ways, a CR survey of nearly 1,200 American adults currently taking prescription drugs has found.

Insurance Changes That Trigger Higher Costs

More than a quarter of people in our survey blamed their insurer for their drug price increase. And for an increasing number of Americans, that’s a reasonable place to start.

Jodi Smith and her family, for example, now have a high-deductible health insurance plan—they must pay about $2,600 for their medical care, including drugs—before insurance kicks in. Such plans typically offer lower monthly premiums, but in exchange you have to pay more out of your own pocket for all your healthcare, including drugs, says Aaron Kesselheim, M.D., an associate professor at Harvard Medical School who researches the cost of prescription drugs.

And high-deductible plans are becoming more common: According to the Centers for Disease Control and Prevention, nearly 40 percent of adults younger than 65 who get insurance through their employer had high-deductible plans in 2016. That’s up from 26 percent in 2011.

Another way drug costs rise is when an insurer, working with its pharmacy benefit manager (PBM)—a middleman company that manages drug benefits for insurers—changes the way it covers drugs. A PBM may stop covering some specific medications from its list and move others to higher, more expensive “tiers.” For example, instead of having a co-pay of only $10 for a particular drug, you may now have to pay $50 or a percentage of the drug’s total cost.

If a PBM drops or reduces coverage for a drug you want to continue taking, odds are you’re going to pay more for that medication—sometimes a lot more, Schondelmeyer says.

Changes to drug coverage usually occur at the beginning of the year. So it pays to confirm that your medications are covered before you sign up or renew coverage during a health insurance open enrollment period, Schondelmeyer says.  

But the changes can also happen without warning throughout the year, even after you’ve signed up. One survey found that half of insurance plans made significant changes to the drugs they covered midway through the year. Such unexpected changes can be especially disruptive, “wreaking havoc on a family’s finances and destroying any sense of security,” says Consumer Reports’ Lipman.

If that happens to you, try to appeal to the insurance company. While such exceptions are uncommon, if your doctor can document that you respond better to a particular medicine, the insurer may grant you a waiver, Lipman says.  

Where Doctors Fall Short

Doctors can help control costs in other ways, too, though it’s not always easy to talk with them about drug costs.

In our survey, most people said they only learned the cost of their new prescription when they got to the pharmacy, not when they were at their doctor’s office. And while 85 percent of people in our survey said they think physicians should ask patients whether they can afford their drugs, more than two-thirds told us they had not had that kind of conversation with their doctor in the previous 12 months.

Even when doctors do discuss the cost of drugs, they don’t always steer patients toward less expensive alternatives. One reason is that patients sometimes ask for costlier brand-name drugs, including those they may have seen advertised on TV. A study in JAMA Internal Medicine found that nearly 40 percent of doctors said they sometimes or often prescribe a pricier brand-name drug at their patient’s request, even when a generic version of the drug is available.  

How to Make Drugs More Affordable

While controlling high drug costs isn’t easy, it is possible. Here are some strategies worth trying:

  • Tell your doctor that cost matters. Speak up when the pre­scription is being written, so your doctor knows that in addition to safety and effectiveness, cost is important, too.

  • Ask about nondrug alternatives. A simple, but often overlooked, way to save money on meds is to make sure you really need a drug in the first place, Schondelmeyer says. For example, cutting back on alcohol and caffeinated beverages, and practicing bladder-strengthening exercises, have been shown to relieve overactive bladder symptoms at least as well as drugs such as tolterodine (Detrol and generic) and oxybutynin (Oxytrol and generic), at a fraction of the cost and with no risk of drug side effects. (Read more about how to avoid unnecessary medications.)

  • Seek out cheaper alternatives. Start by asking about a generic and, if there isn’t one, see about switching to a “therapeutic substitution,” which is a different but similar—and less expensive—medication. For example, if you need an EpiPen auto-injector for allergy emergencies, which can cost $600 for a two-pack, ask instead about generic Adrenaclick, a similar but just as effective product that can cost as little as $10.

  • Ask your pharmacist for a deal. That’s what a quarter of the people in our survey did when a drug shot up in price. And our secret shoppers found that asking this one key question can be surprisingly effective, with pharmacies often offering discount programs or drug coupons. Sometimes these discounts can make a drug even less expensive to pay for out of pocket than if you paid the co-pay and purchased it through your insurance.

  • Shop around. Twenty-two percent of people in our survey who said they got hit with higher drug costs said they looked for a lower price at another drugstore. And again, our secret shoppers found that often pays. Prices varied widely from one pharmacy to the next, even within the same ZIP code.

  • Look for coupons. Go to websites such as Blink Health and GoodRx, which often have discount coupons for common prescription drugs.

Editor’s Note: This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

Additional reporting by Rachel Rabkin Peachman and Lisa Gill.