Roughly 27% of all prescriptions written in the United States are never filled. Among patients facing more than $250 in out-of-pocket cost, that number climbs to 67%. That's according to 2025 data from IQVIA, and it holds true even on plans with strong networks and full drug coverage.
Access to care, whether someone can get the treatment they're prescribed, has traditionally been measured two ways: is there a pharmacy nearby, and is the medication on the formulary. Network adequacy standards require plans to keep enough pharmacies in reach, typically defined by distance and travel time. Formularies are reviewed against a required standard of coverage per drug class. Mail order pharmacy helps solve the first problem: distance. Researchers studying pharmacy access have found that a mail order option could meaningfully close geographic gaps for people in areas with limited pharmacy access, particularly for people in areas with limited pharmacy access, since it removes distance as a barrier entirely. But even with that in place, the second, harder question remains unanswered: does the patient end up starting and staying on the medication?
A plan can meet every traditional standard, a nearby pharmacy, a covered drug, and still lose more than a quarter of its prescriptions. The standard measure only covers what happens before the prescription is written. It stops right where the real risk begins.
What is prescription abandonment?
Prescription abandonment is when a patient never fills a prescription their provider wrote. A nearby pharmacy, a mail order option, a covered drug, these answer whether someone can get a medication. They don't answer whether they will. In between, a prior authorization is needed with no clear visibility of when it will be complete. A patient hits the counter and the price is higher than expected. A plan question goes unanswered long enough that the person just leaves.
Price surprise is one example. The issue often isn't the price itself, it's not knowing it in advance. Research from Harvard, Brigham and Women's Hospital, and CVS Caremark found abandonment as low as 1.4% when the copay is $10 or less, climbing to 67% once out-of-pocket costs cross $250, cited above. A patient who knows a medication will cost $250 can plan for it. A patient who finds out at the register usually doesn't get the chance.
What does this cost employers?
It costs employers real money in lost productivity, not just a worse patient experience. Research in the Journal of Occupational and Environmental Medicine found employees who stay on their medication take up to seven fewer sick days a year than those who don't. For a chronic condition like asthma or COPD alone, adherence has been valued at close to $2,500 per employee per year in productivity. On a workforce of 1,000, that's over $2 million a year in productivity, tied to a single condition. Broader estimates put the cost of unfilled and unused prescriptions to the U.S. health care system at roughly $100 billion a year, a cost that flows back into every employer's premiums whether or not it ever touches their own claims data.
How should employers measure access to care?
Start by asking a different question: what happens between the prescription being written and the patient starting it? Who is monitoring timely prior authorization (PA) reviews and how does a patient know the status of their PA?
A benefit design can look completely healthy on paper while this is happening underneath it. The plans that hold up over time will be the ones paying attention to what happens after the prescription is written, not just the ones with the widest pharmacy network.
That kind of attention is quiet work. It rarely makes it into a headline, but it's why Health Strategists exist: staying close enough to recognize when a patient needs help navigating a prior authorization, a price surprise, or an unanswered question to step in before it turns into a walk-away or a missed dose. The True Rx+ patient app supports a high-tech with high-touch philosophy. It puts a Health Strategist in your pocket to answer some of the most critical questions in prescription management.
Price is often the biggest unknown a patient faces at the counter, and uncertainty itself is part of what drives abandonment. When patients know what a medication will cost before they get there, they can make an informed choice instead of walking away from one. True Rx+ puts those answers directly into a patient's hands. Through the Savings Center, patients can compare prices and see where they can get their medication at the lowest cost. They can also check prior authorization status and connect with a live Health Strategist when questions come up, whether their medication arrives by mail or comes from a local pharmacy.
That's the real point: access to care should be measured by what happens after coverage begins, not just by whether coverage exists.
Questions to ask at your next plan review
- How is prior authorization completion tracked, and are your members able to easily find information on status?
- Do your members know what their drug is going to cost before they get to the counter?
- How quickly can your members access help by chat or phone?
- What happens for a member facing more than $250 in out-of-pocket cost? Is anyone reaching out before they walk away?
These questions should point you toward where the opportunity is. Want to talk through how to close the gap? Reach out to a Health Strategist today.
