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Cost-Related Non-Adherence to Prescribed Medicines Among Older Adults

A Cross-Sectional Analysis of a Survey in 11 Developed Countries
seniors elderly patients doctors insurance


Patients who adhere to the medications prescribed by their clinicians experience better health outcomes than those who do not. Yet people often fail to fill prescriptions or skip recommended doses for various reasons, including high cost. Most developed countries seek to minimize such cost-related nonadherence by ensuring universal access to needed prescription drugs.

Former Commonwealth Fund Harkness Fellow Steven G. Morgan and coauthor Augustine Lee conducted a cross-national comparison of cost-related nonadherence among older adults using data from The Commonwealth Fund’s 2014 International Health Policy Survey, conducted in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. The authors hypothesized that older adults in countries with universal prescription drug coverage would be less likely to report cost as a barrier to prescription compliance.

What the Study Found

Cost-related nonadherence was highest in the U.S., with Canada second-highest. In both countries, many residents pay out of pocket for prescription drugs. Australia ranked third, owing to its high copayment requirements. The prevalence of cost-related nonadherence ranged from 1.6 percent in France to 16.8 percent in the U.S. In most countries, low-income survey respondents and respondents ages 55 to 64 were more likely to report nonadherence related to cost than their higher-income and older peers. The disparity by income was most pronounced in the U.S. and Canada.


Better prescription drug coverage results in lower rates of cost-related nonadherence. The U.S. and Canada could improve adherence, the authors suggest, by implementing universal coverage for prescription drugs. Australia, meanwhile, could broaden access by reducing the standard copayment for prescriptions.

Publication Details



Mary Mahon, Former Vice President, Public Information, The Commonwealth Fund

[email protected]


S. G. Morgan and A. Lee, “Cost-Related Non-Adherence to Prescribed Medicines Among Older Adults: A Cross-Sectional Analysis of a Survey in 11 Developed Countries,” BMJ Open, published online Jan. 31, 2017.