What is the biggest barrier to medication adherence?

• A. Cost
• B. Side effects
• C. Forgetfulness
• D. Complexity of regimen

Answer: (A)

Understanding barriers to taking medications as prescribed often begins with recognizing how financial factors shape access. Cost matters because it directly affects a patient’s ability to obtain the medication for ongoing use. When out-of-pocket costs are high, patients may skip doses, delay refills, or forgo starting a prescribed therapy altogether. This is known as cost-related nonadherence, a pervasive issue that tends to impact a broad range of patients, especially those with chronic conditions, limited insurance coverage, or high medication prices.

Side effects can cause patients to discontinue a medication, and forgetting doses or navigating a complex regimen can undermine adherence. However, these factors vary more by individual circumstances or specific therapies and do not consistently explain nonadherence across diverse populations as strongly as cost does. Cost creates a barrier at the point of access that can affect every refill and every day of treatment, making it the most influential barrier in many real-world settings.

To mitigate this barrier, strategies include prescribing generics when possible, identifying lower-cost alternatives with similar efficacy, enrolling patients in assistance programs, and helping patients navigate insurance or manufacturer savings options. Simplifying regimens and using fixed-dose combinations can also reduce costs and improve adherence in the long run.