NCHS Data Brief ■ No. 184 ■ January 2015

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Strategies Used by Adults to Reduce Their Prescription

Drug Costs: United States, 2013 

Robin A. Cohen, Ph.D.; and Maria A. Villarroel, Ph.D.

Key findings

Data from the National 

Health Interview Survey, 

2013

● To save money, almost

8% of U.S. adults (7.8%) 

did not take their medication 

as prescribed, 15.1% asked 

a doctor for a lower-cost 

medication, 1.6% bought 

prescription drugs from 

another country, and 4.2% used 

alternative therapies. 

● Adults aged 18–64 (8.5%)

were nearly twice as likely 

as adults aged 65 and over 

(4.4%) to have not taken their 

medication as prescribed to 

save money.

● Among adults aged 18–64,

uninsured adults (14.0%) were 

more likely than those with 

Medicaid (10.4%) or private 

coverage (6.1%) to have not 

taken their medication as 

prescribed to save money.

● The poorest adults—those

with incomes below 139% of 

the federal poverty level—were 

the most likely to not take 

medication as prescribed to 

save money. 

Approximately one-fifth (18%) of the $263 billion spent on retail prescription 

drugs in the United States in 2012 was paid out of pocket (1). Some adults 

offset the cost of prescription drugs by reducing the dosage and frequency of 

the recommended pharmacotherapy (2,3). Other cost-saving strategies include 

asking providers for less-expensive medications or purchasing medications 

abroad (4). This report updates previously reported estimates for strategies 

used by U.S. adults aged 18 and over to reduce their prescription drug costs 

(5), using data from the 2013 National Health Interview Survey. 

Keywords: medication • expense • National Health Interview Survey 

Adults used several strategies to reduce prescription drug 

costs.

● Almost 8% of U.S. adults aged 18 and over (7.8%) did not take

medication as prescribed, to save money; 15.1% asked a doctor for a

lower-cost medication, 1.6% bought prescription drugs from another

country, and 4.2% used alternative therapies (Figure 1).

Figure 1. Percentages of adults who used selected strategies to reduce prescription drug costs in 

the last 12 months, by age group: United States, 2013

 
NCHS Data Brief ■ No. 184 ■ January 2015

■ 2  ■

● Adults aged 18–64 (8.5%) were about twice as likely as adults aged 65 and over (4.4%) to

have not taken their medication as prescribed to save money.

● Adults aged 65 and over (16.9%) were more likely than adults aged 18–64 (14.7%) to have

asked their doctor for a lower-cost medication to save money.

● About 5% of adults aged 18–64 had used alternative therapies to save money on prescription

drugs, compared with 1.7% of adults aged 65 and over.

● Less than 2% of adults had bought prescription drugs from another country to save money.

Adults aged 18–64 were almost twice as likely as adults aged 65 and over 

to have skipped doses, to have taken less medicine, and to have delayed 

filling a prescription to save money.

● Among adults aged 18–64, 5.3% skipped doses and 5.6% took less medication to save

money, compared with 2.4% and 2.7%, respectively, of adults aged 65 and over (Figure 2).

● Among adults aged 18–64, 7.2% delayed filling a prescription to save money, compared

with 3.4% of adults aged 65 and over.

Figure 2. Percentages of adults who did not take their medication as prescribed in the past 12 months to save money, by 

strategy and age group: United States, 2013

 

 
NCHS Data Brief ■ No. 184 ■ January 2015

■ 3  ■

Among adults aged 18–64, uninsured persons were more likely than those 

with Medicaid or private coverage to have used strategies to save money 

on prescription drugs. 

● Adults aged 18–64 who were uninsured were more likely to have asked their doctor for a

lower-cost medication (16.5%), to have not taken their medication as prescribed (14.0%), to

have used alternative therapies (9.4%), and to have bought prescription drugs from another

country (4.2%) to save money, compared with those who had private coverage (14.0%,

6.1%, 3.5%, and 1.0%, respectively) and those who had Medicaid coverage (14.0%, 10.4%,

3.9%, and 0.7%, respectively) (Figure 3).

● Those who had Medicaid coverage (10.4%) were more likely than those with private

coverage (6.1%) to have not taken medication as prescribed to save money.

Figure 3. Percentages of adults aged 18–64 who used selected strategies to reduce prescription drug costs in the past 

12 months, by health insurance coverage status: United States, 2013

 

 
NCHS Data Brief ■ No. 184 ■ January 2015

■ 4  ■

Among adults aged 65 and over, strategies used to save money on 

prescription drugs varied by insurance type. 

● Adults aged 65 and over who had private coverage were less likely to have tried to save

money by not taking medication as prescribed (4.0%), compared with those who had both

Medicare and Medicaid coverage (6.4%) (Figure 4).

● Those who had only Medicare coverage (18.1%) or those who had private coverage (18.2%)

were more likely to have asked their doctor for a lower-cost medication to save money,

compared with those who had both Medicare and Medicaid coverage (12.9%).

● There were no differences by health insurance coverage in the percentage who bought

prescription drugs from another country or used alternative therapies to save money.

Figure 4. Percentages of adults aged 65 and over who used selected strategies to reduce prescription drug costs in the 

past 12 months, by health insurance coverage status: United States, 2013

 

 

The poorest adults were the most likely to not take medication as 

prescribed to save money.

● The percentage of adults who did not take medication as prescribed to save money

decreased as income increased among all adults aged 18 and over (Figure 5).

● Among adults aged 18–64, the percentage who asked their doctor for a lower-cost

medication to save money was highest among those with incomes at or below 250% of the
NCHS Data Brief ■ No. 184 ■ January 2015

■ 5  ■

Figure 5. Percentages of adults who did not take medication as prescribed and who asked a doctor for a lower cost 

medication in the past 12 months, by age group and poverty status: United States, 2013

 

 

federal poverty level (FPL). The percentages decreased from 17.3% for those with incomes 

from 139% through 250% FPL to 12.4% among those with incomes above 400% FPL.

● Among adults aged 65 and over, the percentage who asked their doctor for a lower-cost

medication to save money increased from 15.5% among those with incomes below 139%

FPL, to 20.9% among those with incomes from 139% through 250% FPL, and 19.7%

among those with incomes from above 250% through 400% FPL, and then decreased to

12.7% for those with incomes above 400% FPL.

Summary

Among U.S. adults aged 18–64, strategies for reducing prescription drug costs were more 

commonly practiced by those who were uninsured than those who had public or private coverage. 

Lack of health insurance coverage and poverty are recognized risk factors for not taking 

medication as prescribed due to cost (2). This cost-saving strategy may result in poorer health 

status and increased emergency room use and hospitalizations, compared with adults who follow 

their recommended pharmacotherapy (6,7). It is unknown whether adverse health outcomes and 

higher health care costs are also associated with the cost-reduction strategies of alternative 

therapy use or obtaining prescription drugs from abroad (8,9). 
NCHS Data Brief ■ No. 184 ■ January 2015

■ 6  ■

Among adults aged 65 and over, those covered by both Medicare and Medicaid were more 

likely to have not taken their medication as prescribed to save money, but were less likely to 

have asked their doctor for a lower-cost prescription, than those who had private insurance 

coverage. Differences in cost-saving strategies by insurance coverage may be interrelated with 

socioeconomic and other patient characteristics. Belief that the recommended pharmacotherapy is 

needed, and an understanding of the recommended treatment, have been found to be lower among 

older adults who are economically vulnerable, compared with those with higher income (10). 

Income was also associated with the use of cost-reduction strategies. Among adults aged 65 and 

over, those living with incomes at 139%–400% FPL were more likely than adults living in lower 

or higher income thresholds to have asked their provider for a lower-cost prescription to save 

money. These patterns in the estimates by insurance status and poverty level are similar to those 

previously reported using the 2011 NHIS data (5)

Definitions

Strategies for reducing prescription drug costs: Based on the following 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 ...[5] You bought prescription drugs from 

another country to save money ...[6] You used alternative therapies to save money. In contrast 

to previous survey years, adults in 2013 were asked questions 1 through 3 only if they reported 

having been prescribed medication by a doctor or other health care provider during the past 12 

months. Adults who were not prescribed medication in the past 12 months are included in the 

denominator of the estimates pertaining to questions 1 through 3. All adults were asked questions 

4 through 6, including those who might not be taking prescription medication. 

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.

Health insurance coverage: Respondents were asked about their health insurance coverage at 

the time of interview. They reported whether they were covered by private insurance, Medicare, 

Medigap (supplemental Medicare coverage), Medicaid, Children’s Health Insurance Program 

(CHIP), Indian Health Service (IHS), military coverage, a state-sponsored health plan, another 

government program, or any single-service plans. Adults with both private coverage and some 

type of public coverage (e.g., Medicaid or Medicare) were classified as having private coverage 

(11).

Poverty status and percentage of poverty level: Based on reported or imputed family income, 

family size, and the number of children in the family, and, for families with two or fewer adults, 

on the age of the adults in the family. Poverty levels are updated annually by the U.S. Census 

Bureau to reflect changes in the Consumer Price Index. For further information, visit the U.S. 

Census Bureau website at http://www.census.gov/hhes/www/poverty/poverty.html. Note that 

NHIS asked respondents about their personal earnings and family income for the previous 

calendar year (2012). Family income was imputed for 22.7% of persons in 2013 (12).
NCHS Data Brief ■ No. 184 ■ January 2015

■ 7  ■

Data source and methods

Data from the 2013 NHIS were used for this analysis. NHIS data are collected continuously 

throughout the year for the Centers for Disease Control and Prevention’s (CDC) National Center 

for Health Statistics (NCHS) by interviewers from the U.S. Census Bureau. NHIS collects 

information about the health and health care of the civilian noninstitutionalized population of 

the United States. Interviews are conducted in respondents’ homes, but follow-ups to complete 

interviews may be conducted over the telephone. The Family component collects information on 

all family members, and the Sample Adult component collects additional data from one randomly 

selected adult (the “sample adult”). Questions about strategies to reduce prescription drug cost 

are from the Sample Adult component. In 2013, information was collected on a total of 34,557 

sample adults aged 18 and over. For further information about NHIS, including the questionnaire, 

see the NHIS website at http://www.cdc.gov/nchs/nhis.htm.

NHIS is designed to yield a nationally representative sample, and this analysis used weights to 

produce national estimates. Data weighting procedures are described in more detail elsewhere 

(13). All estimates shown in this report meet the NCHS standard of reliability (relative standard 

error less than or equal to 30%). Differences between percentages were evaluated using two-sided 

significance tests at the 0.05 level. 

About the authors

Robin A. Cohen and Maria A. Villarroel are with CDC’s National Center for Health Statistics, 

Division of Health Interview Statistics.

References

1. Centers for Medicare & Medicaid Services. National health expenditure data. Available

from: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/

NationalHealthExpendData/NationalHealthAccountsHistorical.html. 

2. Briesacher BA, Gurwitz JH, Soumerai SB. Patients at-risk for cost-related medication

nonadherence: A review of the literature. J Gen Intern Med 22(6):864–71. 2007.

3. Piette JD, Rosland AM, Silveira MJ, Hayward R, McHorney CA. Medication cost problems

among chronically ill adults in the US: Did the financial crisis make a bad situation even worse? 

Patient Prefer Adherence 5:187–94. 2011. 

4. Nekhlyudov L, Madden J, Graves AJ, Zhang F, Soumerai SB, Ross-Degnan D. Cost-related

medication nonadherence and cost-saving strategies used by elderly Medicare cancer survivors. 

J Cancer Surviv 5(4):395–404. 2011.

5. Cohen RA, Kirzinger WK, Gindi RM. Strategies used by adults to reduce their prescription

drug costs. NCHS data brief, no 119. Hyattsville, MD: National Center for Health Statistics. 

2013.

6. 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.
NCHS Data Brief ■ No. 184 ■ January 2015

U.S. DEPARTMENT OF

HEALTH & HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

3311 Toledo Road, Room 5419

Hyattsville, MD 20782

OFFICIAL BUSINESS 

PENALTY FOR PRIVATE USE, $300

FIRST CLASS MAIL 

POSTAGE & FEES PAID 

CDC/NCHS

PERMIT NO. G-284

7. 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.

8. Herman PM, Poindexter BL, Witt CM, Eisenberg DM. Are

complementary therapies and integrative care cost-effective? A systematic 

review of economic evaluations. BMJ Open 2(5):e001046. 2012.

9. Hubbard WK. Safety of prescription drugs from foreign sources.

Statement before the Subcommittee on Human Rights and Wellness, House 

Committee on Government Reform, June 12, 2003. Available from: http://

www.fda.gov/NewsEvents/Testimony/ucm161056.htm.

10. Piette JD, Beard A, Rosland AM, McHorney CA. Beliefs that influence

cost-related medication non-adherence among the “haves” and “have nots” 

with chronic diseases. Patient Prefer Adherence 5:389–96. 2011.

11. Adams PF, Kirzinger WK, Martinez ME. Summary health statistics

for the U.S. population: National Health Interview Survey, 2012. National 

Center for Health Statistics. Vital Health Stat 10(259). 2013.

12. NCHS. Multiple imputation of family income and personal earnings in

the National Health Interview Survey: Methods and examples. Hyattsville, 

MD: NCHS, Division of Health Interview Statistics. Available from: http://

www.cdc.gov/nchs/nhis/2013imputedincome.htm.

13. Parsons VL, Moriarity CL, Jonas K, et al. Design and estimation for the

National Health Interview Survey, 2006–2015. National Center for Health 

Statistics. Vital Health Stat 2(165). 2014. 

Suggested citation

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.

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

Charles J. Rothwell, M.S., M.B.A., Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health Interview Statistics

Marcie L. Cynamon, Acting Director

For e-mail updates on NCHS publication 

releases, subscribe online at: 

http://www.cdc.gov/nchs/govdelivery.htm.

For questions or general information 

about NCHS: 

Tel: 1–800–CDC–INFO (1–800–232–4636)

TTY: 1–888–232–6348

Internet: http://www.cdc.gov/nchs

Online request form: http://www.cdc.gov/info

ISSN 1941–4927 Print ed. 

ISSN 1941–4935 Online ed. 

DHHS Publication No. 2015–1209

CS253735

For more NCHS Data Briefs, visit:

http://www.cdc.gov/nchs/products/databriefs.htm.