Summary

A survey of more than 1,380 Virginia adults, conducted from August 1 to August 19, 2025, found:

• Nearly half (47%) of all survey respondents reported being either “worried” or “very worried” about affording the cost of prescription drugs;
• More than a quarter of respondents (27%) reported rationing medication due to cost in the last year;
• Respondents earning less than $50,000 a year, those enrolled in coverage they purchased on their own (such as through the Marketplace), and respondents with a disability or who live with a person with a disability reported rationing medication more frequently than other respondents;
• Nearly 3 in every 4 respondents (72%) “agree” or “strongly agree” that the United States health care system needs to change; and
• Across party lines, respondents expressed strong support for policy-based solutions.

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 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 quarter (27%) of respondents reported rationing medication due to cost concerns in the last year (see Figure 1).

Among Virginia respondents, medication rationing was most commonly reported among respondents enrolled in enrolled in coverage they purchased on their own (such as through the Marketplace), followed by those with Medicaid. Other groups also more frequently reported 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 (44%) of all survey respondents identified addressing high health care costs, including drug prices, as one of their top three policy priorities for government action.

Respondents were asked to describe a time that they did not get a healthcare service due to cost, and several individuals reported experiences related to medication.

• “I had to stop taking a prescription drug because the price was too high”
• “The medication I needed was just too new, so it was too expensive for me to get so I had to ask for one that does not work as well.”
• My husband was prescribed a medication that the cost was $799 for 3 months and we could not afford that. Had to go back to Doctor to get a different prescription
• “My Social Security” monthly checks barely cover my basic monthly bills, with very little left over for food, most months medical care, and medications are somethings that I cannot afford. NO money left over at all.”

Worries about Affording the Cost of Prescription Drugs in the Future

Nearly half (47%) 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 frequent 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 Virginia respondents are generally dissatisfied with the health care system. In fact, just 32% 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.

Virginia 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:  

• 74% — Drug companies charging too much money
• 72% — Hospitals charging too much money 
• 71% — Insurance companies charging too much money

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

• 93% — Cap out-of-pocket costs for life-saving medications, such as insulin;
• 92% — Authorize the Attorney General to take legal action to prevent price gouging;
• 92% — Set standard prices for drugs to make them affordable;
• 90% — Prohibit drug companies from charging more in the U.S. than abroad; and
• 89% — 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. For example, nearly all (92%) respondents agreed that states should authorize the Attorney General to take legal action to prevent price gouging or unfair drug price hikes, including 92% of respondents identifying as a Republican, 92% of respondents identifying as a Democrat, and 93% of independent 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 Virginia respondents, please see Healthcare Value Hub, Virginia Survey Respondents Struggle to Afford High Health Care Costs; Worry about Affording Health Care in the Future; Express Bipartisan Support for Policy Solutions, Data Brief (October 2025).

Notes

¹ Mulcahy, A., Schwam, D., Lovejoy, S. (2024, February 1). International Prescription Drug Price Comparisons: Estimates Using 2022 Data. RAND Corporation. https://www.rand.org/pubs/research_reports/RRA788-3.html

² NCHS Data Query System. (2024). Prescription Medication Use Among Adults [Internet]. Hyattsville (MD): National Center for Health Statistics. https://www.cdc.gov/nchs/dqs

³ Nekui, F., Galbraith, A. A., Briesacher, B. A., Zhang, F., Soumerai, S. B., Ross-Degnan, D., Gurwitz, J. H., & Madden, J. M. (2021). Cost-related Medication Nonadherence and Its Risk Factors Among Medicare Beneficiaries. Medical care, 59(1), 13–21. https://doi.org/10.1097/MLR.0000000000001458

⁴ Understanding the Use of Medicines in the U.S. 2025: Evolving Standards of Care, Patient Access, and Spending. (2025, April). IQVIA Institute for Human Data Science. https://www.iqvia.com/-/media/iqvia/pdfs/institute-reports/understanding-the-use-of-medicines-in-the-us-2025/iqvia-institute-iqi-us-use-of-medicines-04-25-forweb.pdf

⁵ Median household income in Virginia was $89,931. U.S. Census Bureau (2023). American Community Survey 1-year estimates. Retrieved from Census Reporter Profile page for Virginia, http://censusreporter.org/profiles/04000US51-virginia/   

Methodology

Altarum’s Consumer Healthcare Experience State Survey (CHESS) is designed to elicit respondents’ 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 August 1 to August 19, 2025, used a web panel from Dynata with a demographically balanced sample of respondents who live in Virginia. 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 1,385 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.