Cost prevents 1 in 6 U.S. adults with asthma from following prescription, study finds

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Financial barriers prevent one in six U.S. adults with asthma from taking their medications as prescribed, significantly increasing their risk of asthma attacks and emergency department (ED) visits, according to research published in the respiratory medicine journal, Thorax.

The research, based on data from the National Health Interview Survey (NHIS) from 2011 to 2022, demonstrates that cost-related non-adherence to asthma medications remains a pressing issue, despite a declining trend over the last 12 years. The findings emphasize the need for health care policies that improve equitable access to medications.

“Since asthma is one of the leading chronic diseases, the burden of cost-related non-adherence to medications highlights the need for appropriate policies and social supports to address such problems,” the authors of the report wrote.

Among 30,793 U.S. adults with asthma surveyed:

• 18% reported cost-related non-adherence to medications—equating to nearly three million U.S. adults with asthma.
  • 12% (1.95 million adults equivalent) have skipped doses to save money.
  • 12.5% (2.06 million adults equivalent) cut back on/took fewer doses to save money.
  • 15% (2.54 million adults equivalent) delayed refilling prescriptions.
• Adults citing financial hardships had nearly double the risk of asthma attacks and were roughly 60% more likely to visit an ED compared to those without financial barriers.

Despite the proportion of respondents reporting cost-related non-adherence to medications having decreased from 23% in 2011 to 13% in 2022, significant disparities persist. Women, individuals between the ages of 18-60, Black adults, those with lower incomes or educational attainment and residents of Southern U.S. states were among specific populations that were more likely to report cost-related barriers.

Policy implications

The authors of the report attribute the falling trend in people citing cost-related non-adherence to medications to policies like the Patient Protection and Affordable Care Act in 2010 and the expansion of Medicaid in 2014, which reduced barriers to health care access. However, asthma medications—which account for half of the total costs associated with the condition—are not yet included in Medicare’s drug price negotiation program established by the Inflation Reduction Act, which has lowered drug costs for several chronic conditions.

“Efforts to reduce cost-related medication non-adherence not only lessen the financial burden on the U.S. health system, but also support people’s ability to improve their disease symptoms,” Emily Graul and Christer Janson, MD, PhD, of, respectively, Emory University School of Medicine and Uppsala University, in Sweden, suggested in a linked editorial, also published in Thorax.

The editorial calls for expanded legislative measures, suggesting the inclusion of asthma medications in future rounds of Medicare’s drug price negotiations. With millions of U.S. adults at heightened risk of preventable asthma-related complications, researchers and experts involved in this report urge policymakers to prioritize access to affordable medications in future health care reforms.