According to a survey of more than 1,400 North Carolina adults, conducted from October 18 to October 23, 2023, respondents are concerned about prescription drug costs and express a strong desire for policymakers to enact solutions.

More than half (58%) 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 households at all income levels reported high levels of worry.

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In addition to being worried about prescription drug affordability in the future, many North Carolina respondents have skipped, delayed, or avoided care altogether in the prior 12 months due to the cost. 1 in 3 respondents (33%) 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).

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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 North Carolina 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 North Carolina 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 75% agreed or strongly agreed that “the system needs to change.”

North Carolina respondents see a role for themselves in addressing prescription drug affordability. When asked about specific actions they could take:

• 59% of respondents reported researching the cost of a drug beforehand, and
• 80% said they would be willing to switch from a brand name to an equivalent generic drug if given the chance.

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

• 77%—Drug companies charging too much money
• 73%—Hospitals charging too much money
• 70%—Insurance companies charging too much money

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

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

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

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Conclusion

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.

Notes

1. Median household income in North Carolina was $60,516 (2017-2021). U.S. Census, Quick Facts. Retrieved from: U.S.Census Bureau QuickFacts
2. For more detailed information about healthcare affordability burdens facing North Carolina respondents, please see Healthcare Value Hub, North Carolina Residents Struggle to Afford High Healthcare Costs; Worry About Affording Healthcare in the Future; Support Government Action across Party Lines, Data Brief (December 2023).

Methodology

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 October 18 to October 23, 2023, used a web panel from online survey company Dynata with a demographically balanced sample of approximately 1,500 respondents who live in North Carolina. 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 1,455 cases for analysis. After those exclusions, the demographic composition of respondents was as follows, although not all demographic information has complete response rates:

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.

Appendix

Black Belt	Non-Rural	Rural
Anson County, North Carolina	Alamance County, North Carolina	Alleghany County, North Carolina
Bertie County, North Carolina	Alexander County, North Carolina	Ashe County, North Carolina
Bladen County, North Carolina	Brunswick County, North Carolina	Avery County, North Carolina
Columbus County, North Carolina	Buncombe County, North Carolina	Beaufort County, North Carolina
Cumberland County, North Carolina	Burke County, North Carolina	Camden County, North Carolina
Duplin County, North Carolina	Cabarrus County, North Carolina	Carteret County, North Carolina
Edgecombe County, North Carolina	Caldwell County, North Carolina	Caswell County, North Carolina
Franklin County, North Carolina	Catawba County, North Carolina	Cherokee County, North Carolina
Gates County, North Carolina	Chatham County, North Carolina	Chowan County, North Carolina
Granville County, North Carolina	Craven County, North Carolina	Clay County, North Carolina
Greene County, North Carolina	Currituck County, North Carolina	Cleveland County, North Carolina
Halifax County, North Carolina	Davidson County, North Carolina	Dare County, North Carolina
Hertford County, North Carolina	Davie County, North Carolina	Graham County, North Carolina
Hoke County, North Carolina	Durham County, North Carolina	Harnett County, North Carolina
Lenoir County, North Carolina	Forsyth County, North Carolina	Hyde County, North Carolina
Martin County, North Carolina	Gaston County, North Carolina	Jackson County, North Carolina
Nash County, North Carolina	Guilford County, North Carolina	Lee County, North Carolina
Northampton County, North Carolina	Haywood County, North Carolina	McDowell County, North Carolina
Pitt County, North Carolina	Henderson County, North Carolina	Macon County, North Carolina
Richmond County, North Carolina	Iredell County, North Carolina	Mitchell County, North Carolina
Robeson County, North Carolina	Johnston County, North Carolina	Montgomery County, North Carolina
Sampson County, North Carolina	Jones County, North Carolina	Moore County, North Carolina
Scotland County, North Carolina	Lincoln County, North Carolina	Pasquotank County, North Carolina
Tyrrell County, North Carolina	Madison County, North Carolina	Perquimans County, North Carolina
Vance County, North Carolina	Mecklenburg County, North Carolina	Polk County, North Carolina
Warren County, North Carolina	New Hanover County, North Carolina	Rutherford County, North Carolina
Washington County, North Carolina	Onslow County, North Carolina	Stanly County, North Carolina
Wayne County, North Carolina	Orange County, North Carolina	Surry County, North Carolina
Wilson County, North Carolina	Pamlico County, North Carolina	Swain County, North Carolina
	Pender County, North Carolina	Transylvania County, North Carolina
	Person County, North Carolina	Watauga County, North Carolina
	Randolph County, North Carolina	Wilkes County, North Carolina
	Rockingham County, North Carolina	Yancey County, North Carolina
	Rowan County, North Carolina
	Stokes County, North Carolina
	Union County, North Carolina
	Wake County, North Carolina
	Yadkin County, North Carolina