Summary

Prescription drug prices in the United States are nearly 2.8 times higher than the prices in other OECD countries, like Canada, Japan, and France.¹ With nearly seven in every ten American adults (69%) prescribed at least one medication, these high costs impact the majority of the population to some degree.² Although many survey respondents (72%) indicated that they would switch to a lower-cost generic alternative if given the opportunity, this option is not always available — leaving some patients without an affordable way to access necessary medications.

Medication Rationing

When prescription drugs are unaffordable, patients may be forced to ration the medications they have on hand by skipping doses or splitting pills in half, or they may not be able to fill their prescription at all. Individuals who ration medication often experience worse health outcomes and more frequently use health care services relative to patients who take their medication as prescribed.³ More than one in every four (31% of) respondents reported rationing medication due to cost concerns in the last year (see Figure 1).

Among Tennessee respondents, medication rationing was most commonly reported among respondents enrolled in TennCare, followed by those with insurance purchased independently. However, certain population were more likely to report rationing medication, such as respondents earning less than $50,000 a year and respondents with a disability or living in a household with a person with a disability (see Table 1).

Nationally, rationing behaviors occur across income and insurance status — approximately 27% of prescriptions written to insured American adults go unfilled due to insurance coverage denials. ⁴ While some patients are able to overcome these obstacles by using secondary insurance, paying out-of-pocket, or applying manufacturer coupons, nearly half 41%) of survey respondents identified addressing high health care costs, including drug prices, as one of their top three policy priorities for government action.

When asked to provide more details on why they rationed medication in the last year, respondents provided a variety of anecdotes, including:

Worries about Affording the Cost of Prescription Drugs in the Future

More than half (51%) of survey respondents reported being somewhat or very worried about affording the cost of prescription drugs. Worry varies by income group, with respondents in households making less than $50,000 per year experiencing the most worry (see Table 2).⁵ However, a large percentage of households making above $75,000 per year also reported worrying about the cost of prescription drugs. 

Respondent Perceptions of Health Care Systems, Policy Solutions

Given how often respondents reported being concerned about affording prescription drugs, it is not surprising that Tennessee respondents are generally dissatisfied with the health care system. In fact, just 38% of respondents agreed or strongly agreed that the United States health care system is “great,” while 72% agreed or strongly agreed that the United States health care system needs to change.

Tennessee respondents also frequently reported that they believe that pricing decisions made by drug companies are a major reason for high health care costs. In fact, out of fifteen options, the most frequently cited reasons for high health care costs were:  

• 73% — Drug companies charging too much money
• 69% — Insurance companies charging too much money
• 70% — Hospitals charging too much money 

When asked about their views on policy solutions to address the high cost of prescription drugs, Tennessee respondents endorsed a number of prescription drug-related strategies, including:

• 91% — Cap out-of-pocket costs for life-saving medications, such as insulin;
• 91% — Set standard prices for drugs to make them affordable;
• 90% — Prohibit drug companies from charging more in the U.S. than abroad; and
• 90% — Authorize the Attorney General to take legal action to prevent price gouging;
• 90% — Establish a Prescription Drug Affordability Board to examine evidence and establish acceptable costs for prescription drugs.

The survey also revealed that there is bipartisan support for a variety of policies designed to make prescription drugs more affordable. Nearly all (91% of) respondents agreed that drug companies should be required to provide advance notice of price increases and to provide information to justify those increases, including 91% of respondents identifying as a Republican, 95% of respondents identifying as a Democrat, and 90% of unaffiliated respondents (see Table 3).

The high burden of health care and prescription drug affordability, along with high levels of support for change, suggests that elected leaders need to make addressing this consumer burden a top priority. Annual surveys can help assess whether progress is being made. For more detailed information about health care affordability burdens facing Tennessee respondents, please see Healthcare Value Hub, Tennessee Residents Struggle to Afford High Health Care Costs; Worry About Affording Health Care in the Future; Support Government Action across Party Lines, Data Brief (September 2025).