Data Brief | | March 2024

Texas Survey Respondents Worried about High Drug Costs; Support a Range of Government Solutions

According to a survey of more than 1,400 Texas adults, conducted from November 7 to November 13,
2023, respondents are concerned about prescription drug costs and express a strong desire for
policymakers to enact solutions.

More than half (59%) of survey respondents reported being somewhat or very worried about affording
the cost of prescription drugs. Worry varied substantially by income group, with respondents in
households making less than $50,000 per year1 experiencing the most worry (see Figure 1). However, it is important to note that a large percentage of households making above $75,000 per year also reported
worrying about prescription drugs.

TX_RxAffordability_Brief 2024_Figure1.png

In addition to being worried about prescription drug affordability in the future, many Texas respondents
have skipped, delayed, or avoided care altogether in the prior 12 months due to the cost. Indeed, nearly one-third of respondents (32%) reported rationing medication by either not filling a prescription, cutting pills in half, or skipping a dose of medicine in the last year due to cost (see Figure 2).

TX_RxAffordability_Brief 2024_Figure2.png

TX_RxAffordability_Brief 2024_Table1.png

These hardships disproportionately impact people in lower-income households. As Table 1 shows,
respondents living in households earning less than $50,000 and those earning between $50,000 and
$75,000 per year reported higher rates of rationing their prescription medicines than respondents living
in higher-income households. However, these hardships are alarmingly prevalent in middle-income
households as well.

Respondents with Texas Medicaid coverage reported the highest rates of rationing medication compared
to other insurance types, followed by those with private insurance. Finally, respondents living in
households with a person with a disability reported notably higher rates of rationing medication due to
cost in the past 12 months compared to respondents without a disabled household member (see Table 1).

Considering these prescription drug cost concerns—as well as concerns about high healthcare costs
generally2—it is not surprising that Texas respondents were generally dissatisfied with the health system:

  • Just 30% agreed or strongly agreed that “we have a great healthcare system in the U.S.,”
  • While 72% agreed or strongly agreed that “the system needs to change.”

When given more than 20 options, the options cited most frequently as being a "major reason" for high
healthcare costs were:

  • 74%—Hospitals charging too much money
  • 73%—Drug companies charging too much money
  • 69%—Insurance companies charging too much money

When it comes to tackling high drug costs, Texas respondents endorsed a number of prescription drug-
related strategies:

  • 92%—Require drug companies to provide advanced notice of price increases and information to justify those increases
  • 92%—Set standard prices for drugs to make them affordable
  • 91%—Cap out-of-pocket costs for life-saving medications, such as insulin
  • 91%—Authorize the Attorney General to take legal action to prevent price gouging or unfair prescription drug price hikes
  • 90%—Prohibit drug companies from charging more in the U.S. than abroad
  • 89%—Create a Prescription Drug Affordability Board to examine the evidence and establish acceptable costs for drugs

Moreover, there is substantial support for government action on drug costs regardless of the
respondent’s political affiliation (see Table 2).

While Texas respondents are united in calling for the government to address high drug costs, they also see a role for themselves:

  • 77% would switch from a brand name to an equivalent generic drug if given a chance
  • 61% find, or have tried to find, out the cost of a drug beforehand

TX_RxAffordability_Brief 2024_Table2.png


The high burden of healthcare and prescription drug affordability, along with high levels of support for
change, suggests that elected leaders and other stakeholders need to make addressing this consumer
burden a top priority. Moreover, the COVID crisis has led state residents to take a hard look at how well
health and public health systems are working for them, with strong support for a wide variety of actions.
Annual surveys can help assess whether progress is being made.


  1. Median household income in Texas was $73,035 (2017-2021). U.S. Census, Quick Facts. Retrieved from: U.S. Census Bureau QuickFacts: Texas
  2. For more detailed information about healthcare affordability burdens facing Texas respondents, please see Healthcare Value Hub, Texas Residents Struggle to Afford High Healthcare Costs; Worry About Affording Healthcare in the Future; Support Government Action across Party Lines, Data Brief (March 2024).


Altarum’s Consumer Healthcare Experience State Survey (CHESS) is designed to elicit respondents’ unbiased views on a wide range of health system issues, including confidence using the health system, financial burden and possible policy solutions.

This survey, conducted from November 7 to November 13, 2023, used a web panel from online survey company Dynata with a demographically balanced sample of approximately 1,500 respondents who live in Texas. Information about Dynata’s recruitment and compensation methods can be found here. The survey was conducted in English or Spanish and restricted to adults ages 18 and older. Respondents who finished the survey in less than half the median time were excluded from the final sample, leaving
1,405 cases for analysis. After those exclusions, the demographic composition of respondents was as follows, although not all demographic information has complete response rates:

TX_RxAffordability_Brief 2024_Methodology.png

Percentages in the body of the brief are based on weighted values, while the data presented in the demographic table is unweighted. An explanation of weighted versus unweighted variables is available here. Altarum does not conduct statistical calculations on the significance of differences between groups in findings. Therefore, determinations that one group experienced a significantly different affordability burden than another should not be inferred. Rather, comparisons are for conversational purposes. The groups selected for this brief were selected by advocate partners in each state based on organizational/advocacy priorities. We do not report any estimates under N=100 and a co-efficient of variance more than 0.30.