NCHS Data Brief ■ No. 335 ■ May 2019

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Strategies Used by Adults Aged 65 and Over to Reduce Their 

Prescription Drug Costs, 2016–2017

Robin A. Cohen, Ph.D., and Peter Boersma, M.P.H.

Key findings

Data from the National 

Health Interview Survey

● Among adults aged 65 and 

over who were prescribed 

medication in the past

12 months, 4.8% did not take 

their medication as prescribed 

to reduce their prescription 

drug costs, and 17.7% asked 

their doctor for a lower-cost 

medication. 

● Women (5.6%) were more 

likely than men (3.7%) to 

not take their medication as 

prescribed. 

● Adults aged 65–74 were 

more likely than those aged 

75 and over to not take their 

medication as prescribed and to 

ask their doctor for a lower-cost 

medication.

● Adults with Medicare 

only were more likely than 

adults with private coverage, 

Medicare and Medicaid, or 

Medicare Advantage to not take 

their medication as prescribed. 

● Adults who were near poor 

were more likely than those 

who were poor or not poor to 

ask for a lower-cost medication.

In 2017, 86% of U.S. adults aged 65 and over reported being prescribed 

medication in the past 12 months (1). Most adults aged 65 and over have 

prescription drug coverage through either Medicare Part D or some source 

such as private health insurance, Medicaid, or Veterans Administration 

coverage (2). However, previous data indicate that some may still use 

strategies to reduce prescription drug costs, including not taking their 

medication as prescribed or asking their doctor for a lower-cost medication 

(3). This report examines the percentage of adults aged 65 and over who used 

these strategies to reduce their prescription drug costs in the past 12 months by 

selected characteristics.

Among adults aged 65 and over prescribed medication in the 

past 12 months, women were more likely than men to not take 

their medication as prescribed to save money.

NCHS reports can be downloaded from: https://www.cdc.gov/nchs/products/index.htm.

Figure 1. Percentage of adults aged 65 and over who were prescribed medication in the past 

12 months and used selected strategies to reduce their prescription drug costs, by sex:

United States, 2016–2017

1

Significantly different from women (p < 0.05).

NOTES: “Did not take medication as prescribed” is a composite measure that includes adults who “skipped medication doses,” 

“took less medicine,“ or “delayed filling a prescription.” See Definitions section for further details. A person may use more than

one strategy to reduce prescription drug costs. Estimates are based on household interviews of a sample of the civilian

noninstitutionalized population. Access data table for Figure 1 at: https://www.cdc.gov/nchs/data/databriefs/db335_

tables-508.pdf#1.

SOURCE: NCHS, National Health Interview Survey, 2016–2017.

Total Men Women

Percent

0

5

10

15

20

25

Did not take medication as prescribed Asked doctor for lower-cost medication

4.8 1

3.7

5.6

17.7 17.0

18.3
NCHS Data Brief ■ No. 335 ■ May 2019

■  2  ■

● In 2016–2017, among adults aged 65 and over who were prescribed medication in the past 

12 months, 4.8% did not take their medication as prescribed, and 17.7% asked their doctor 

for a lower-cost medication (Figure 1).

● Women (5.6%) were more likely than men (3.7%) to not take their medication as prescribed. 

● The percentage of women who asked their doctor for a lower-cost medication (18.3%) was 

similar to that of men (17.0%).

Adults aged 65–74 were more likely than those aged 75 and over to not 

take their medication as prescribed and to ask their doctor for a lower-cost 

medication.

● Among adults aged 65 and over who were prescribed medication in the past 12 months, 

those aged 65–74 (6.1%) were twice as likely as those aged 75 and over (2.9%) to not take 

their medication as prescribed (Figure 2).

● Adults aged 65–74 (19.9%) were more likely than those aged 75 and over (14.6%) to ask 

their doctor for a lower-cost medication.

Figure 2. Percentage of adults aged 65 and over who were prescribed medication in the past 12 months and used 

selected strategies to reduce their prescription drug costs, by age group: United States, 2016–2017

1

Significantly different from adults aged 75 and over (p < 0.05).

NOTES: “Did not take medication as prescribed” is a composite measure that includes adults who “skipped medication doses,” “took less medicine,“ or “delayed 

filling a prescription.” See Definitions section for further details. A person may use more than one strategy to reduce prescription drug costs. Estimates are based 

on household interviews of a sample of the civilian noninstitutionalized population. Access data table for Figure 2 at: https://www.cdc.gov/nchs/data/

databriefs/db335_tables-508.pdf#2.

SOURCE: NCHS, National Health Interview Survey, 2016–2017. Percent

4.8

1

6.1

2.9

17.7

1

19.9

14.6

0

5

10

15

20

25

Total 65–74 75 and over

Did not take medication as prescribed Asked doctor for lower-cost medication
NCHS Data Brief ■ No. 335 ■ May 2019

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Among adults aged 65 and over, strategies used to reduce prescription 

drug costs varied by health insurance coverage.

● Among adults aged 65 and over who were prescribed medication in the past 12 months, 

those with Medicare only (8.1%) were more likely than those with Medicare Advantage 

(5.5%), Medicare and Medicaid (5.2%), or private coverage (3.1%) to not take their 

medication as prescribed to save money (Figure 3). 

● The percentage of adults aged 65 and over who did not take their medication as prescribed 

to save money was lowest among those with private coverage (3.1%) compared with those 

having Medicare and Medicaid, Medicaid Advantage plans, or Medicare only. 

● Adults aged 65 and over with Medicare only (20.4%), Medicare Advantage (19.2%), or 

private coverage (18.4%) were more likely than those with Medicare and Medicaid (14.1%) 

to ask their doctor for a lower-cost medication.

0

5

10

15

20

25

Private Medicare and Medicaid Medicare Advantage Medicare only

1–33.1

3

5.2 3

5.5

1

18.4

19.2

20.4

2,314.1

8.1

Figure 3. Percentage of adults aged 65 and over who were prescribed medication in the past 12 months and used 

selected strategies to reduce their prescription drug costs, by insurance coverage status: United States, 2016–2017

1

Significantly different from those with Medicare and Medicaid (p < 0.05). 2

Significantly different from those with Medicare Advantage (p < 0.05). 3

Significantly different from those with Medicare only (p < 0.05).

NOTES: “Did not take medication as prescribed” is a composite measure that includes adults who “skipped medication doses,” “took less medicine,“ or “delayed 

filling a prescription.” See Definitions section for further details. A person may use more than one strategy to reduce prescription drug costs. Estimates are based 

on household interviews of a sample of the civilian noninstitutionalized population. Access data table for Figure 3 at: https://www.cdc.gov/nchs/data/

databriefs/db335_tables-508.pdf#3.

SOURCE: NCHS, National Health Interview Survey, 2016–2017. Percent

Did not take medication as prescribed Asked doctor for lower-cost medication
NCHS Data Brief ■ No. 335 ■ May 2019

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Among adults aged 65 and over, strategies used to reduce their 

prescription drug costs varied by poverty status.

● Among adults aged 65 and over who were prescribed medication in the past 12 months, 

those who were poor (7.6%) and those who were near poor (8.9%) were more likely than 

those who were not poor (3.3%) to not take their medication as prescribed to reduce their 

prescription drug costs (Figure 4).

● Adults who were near poor (21.2%) were more likely than those who were poor (17.3%) 

and those who were not poor (16.8%) to ask their doctor for a lower-cost medication.

Figure 4. Percentage of adults aged 65 and over who were prescribed medication in the past 12 months and used 

selected strategies to reduce their prescription drug costs, by poverty status: United States, 2016–2017

1

Significantly different from those who are not poor (p < 0.05). 2

Significantly different from those who are poor and not poor (p < 0.05).

NOTES: “Did not take medication as prescribed” is a composite measure that includes adults who “skipped medication doses,” “took less medicine,“ or “delayed 

filling a prescription.” See Definitions section for further details. A person may use more than one strategy to reduce prescription drug costs. Estimates are based 

on household interviews of a sample of the civilian noninstitutionalized population. Access data table for Figure 4 at: https://www.cdc.gov/nchs/data/

databriefs/db335_tables-508.pdf#4. 

SOURCE: NCHS, National Health Interview Survey, 2016–2017. Percent

1

7.6

1

8.9

3.3

17.3

2

21.2

16.8

0

5

10

15

20

25

Poor Near poor Not poor

Did not take medication as prescribed Asked doctor for lower-cost medication
NCHS Data Brief ■ No. 335 ■ May 2019

■  5  ■

Summary

In 2016–2017, among U.S. adults aged 65 and over who were prescribed medication in the past 

12 months, the percentage who did not take their medication as prescribed or asked their doctor 

for a lower-cost medication to reduce their prescription drug costs varied by sex, age, insurance 

status, and poverty status. Among adults aged 65 and over, women, those aged 65–74, those with 

Medicare only, and those who were near poor were the most likely to not take their medication as 

prescribed. Adults aged 75 and over, those with Medicare and Medicaid coverage, and those who 

were not poor were the least likely to ask their doctor for a lower-cost medication. 

In 2017, prescriptions for chronic conditions accounted for more than two-thirds of all the 

prescriptions in the United States (4). In 2016, 61.7% of adults aged 65 and over had at least 

two or more chronic conditions (5). In 2017, among adults aged 75 and over, 19.8% had been 

diagnosed with diabetes, 59.8% with hypertension, and 55.4% with arthritis (6). However, note 

that the National Health Interview Survey (NHIS) does not have information about the types of 

medication for which cost-saving strategies were used. Cost-saving strategies to reduce prescription 

drug costs may have implications for health status and have been associated with increased 

emergency room use and hospitalizations compared with adults who follow recommended 

pharmacotherapy (7,8).

Definitions

Strategies for reducing prescription drug costs: Based on the survey questions: The following 

questions concern the use of prescription medication: During the past 12 months, are any of the 

following true for you? ... [1] You skipped medication doses to save money ... [2] You took less 

medicine to save money ... [3] You delayed filling a prescription to save money ... [4] You asked 

your doctor for a lower-cost medication to save money. Adults were asked questions 1 through 4 

only if they reported having been prescribed medication by a doctor or other health care provider 

during the past 12 months. For this analysis, only those adults who were prescribed medication in 

the past 12 months were included. 

Did not take medication as prescribed: Based on a positive response to any of the following three 

questions described previously: ... You skipped medication doses to save money ... You took less 

medicine to save money ... You delayed filling a prescription to save money.

Poverty status: Categories are based on the ratio of the family’s income in the previous calendar 

year to the appropriate poverty threshold (given the family’s size and number of children), as 

defined by the U.S. Census Bureau. Adults were considered poor if their family poverty level fell 

below 100% of the threshold. Adults were considered near poor if their family poverty level fell 

at or above 100% but below 200%. Adults were considered not poor if their family poverty level 

fell at or above 200%.
NCHS Data Brief ■ No. 335 ■ May 2019

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Health insurance coverage: At the time of interview, respondents reported their type(s) of 

coverage. A health insurance hierarchy of six mutually exclusive categories was developed (9,10). 

Adults with more than one type of health insurance were assigned to the first appropriate category 

in the following hierarchy: Private coverage, Medicare and Medicaid, Medicare Advantage, 

Medicare only (no Advantage), other coverage, and uninsured. Due to small sample sizes, adults 

with “other coverage” and those who are uninsured are included in the totals but are not shown 

separately.

In this report, strategies used to reduce prescription drug costs are based on the 12 months prior 

to interview, while health insurance coverage was measured at the time of interview. Therefore, 

adults’ health insurance status may have been different at the time they used a strategy to reduce 

their prescription drug costs.

Data source and methods

Data from the 2016–2017 NHIS were used for this analysis. NHIS is a nationally representative, 

household survey of the civilian noninstitutionalized U.S. population. It is conducted 

continuously throughout the year by the National Center for Health Statistics (NCHS). Interviews 

are conducted in the respondent’s home, but follow-ups to complete interviews may be conducted 

by telephone when necessary. For more information about NHIS, visit the NHIS website at: 

https://www.cdc.gov/nchs/nhis.htm. 

Point estimates and the corresponding variances were calculated using SUDAAN software (11) 

to account for the complex sample design of NHIS. All estimates in this report meet NCHS 

standards of reliability as specified in, “National Center for Health Statistics Data Presentation 

Standards for Proportions” (12). Linear and quadratic trends by poverty status were evaluated 

using logistic regression. Differences between percentages were evaluated using two-sided 

significance tests at the 0.05 level. 

About the authors

Robin A. Cohen and Peter Boersma are with the National Center for Health Statistics, Division of 

Health Interview Statistics.
NCHS Data Brief ■ No. 335 ■ May 2019

■  7  ■

References

1. Boersma P, Cohen RA, Vahratian A. QuickStats: Percentage of adults aged ≥ 18 years who 

were prescribed medication in the past 12 months, by sex and age group—National Health 

Interview Survey, 2017. MMWR 68(4):97. 2019.

2. Medicare Payment Advisory Commission. June 2018 data book: Health care spending and the 

Medicare program. 2018. Available from: http://medpac.gov/-documents-/data-book.

3. Cohen RA, Villarroel MA. Strategies used by adults to reduce their prescription drug costs: 

United States, 2013. NCHS Data Brief, no 184. Hyattsville, MD: National Center for Health 

Statistics. 2015.

4. IQVIA Institute for Human Data Science. Medicine use and spending in the U.S.: A review 

of 2017 and outlook to 2022. 2018. Available from: https://www.iqvia.com/institute/reports/

medicine-use-and-spending-in-the-us-review-of-2017-outlook-to-2022. 

5. National Center for Health Statistics. Health, United States, 2017: With special feature on 

mortality. Hyattsville, MD. 2018.

6. Blackwell DL, Villarroel MA. Tables of summary health statistics for U.S. adults: 2017 

National Health Interview Survey. National Center for Health Statistics. 2018. Available from: 

https://www.cdc.gov/nchs/nhis/SHS/tables.htm.

7. Heisler M, Choi H, Rosen AB, Vijan S, Kabeto M, Langa KM, Piette JD. Hospitalizations 

and deaths among adults with cardiovascular disease who underuse medications because of cost: 

A longitudinal analysis. Med Care 48(2):87–94. 2010.

8. Jha AK, Aubert RE, Yao J, Teagarden JR, Epstein RS. Greater adherence to diabetes drugs 

is linked to less hospital use and could save nearly $5 billion annually. Health Aff (Millwood) 

31(8):1836–46. 2012.

9. National Center for Health Statistics. Data file documentation, National Health Interview 

Survey, 2015 (machine-readable data file and documentation). 2016. Available from:

https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHIS/2015/srvydesc.

pdf. 

10. National Center for Health Statistics. Technical notes for summary health statistics tables: 

National Health Interview Survey. Available from: https://www.cdc.gov/nchs/data/nhis/SHS_Tech_

Notes.pdf.

11. RTI International. SUDAAN (Release 11.0.01) [computer software]. 2013.

12. Parker JD, Talih M, Malec DJ, Beresovsky V, Carroll M, Gonzalez Jr JF. National Center 

for Health Statistics Data Presentation Standards for Proportions. National Center for Health 

Statistics. Vital Health Stat 2(175). 2017. Available from: https://www.cdc.gov/nchs/data/series/

sr_02/sr02_175.pdf.
NCHS Data Brief ■ No. 335 ■ May 2019

Keywords: medication • nonadherence • National Health Interview Survey Suggested citation

Cohen RA, Boersma P. Strategies used 

by adults aged 65 and over to reduce their 

prescription drug costs, 2016–2017. NCHS 

Data Brief, no 335. Hyattsville, MD: 

National Center for Health Statistics. 2019.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Jennifer H. Madans, Ph.D., Acting Director

Amy M. Branum, Ph.D., Acting Associate 

Director for Science

Division of Health Interview Statistics

Stephen J. Blumberg, Ph.D., Director

Anjel Vahratian, Ph.D., M.P.H., Associate 

Director for Science

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