Drug Prices Breaking Point

Executive summary

America's prescription drug affordability crisis is no longer an abstract policy debate — it is reshaping how millions of people take their medicine. A new survey of 202 Americans finds that nearly eight in ten respondents (77.6%) are concerned about affording necessary prescription drugs, and 44.3% describe themselves as "very concerned" — a level of distress roughly double the 22% "very worried" share recorded in KFF's nationally representative polling.

The consequences are clinical, not just financial. Among respondents who take prescription medications, roughly 60% report at least one cost-driven behavior in the past year: skipping doses, declining to refill a prescription, or substituting a cheaper alternative. That non-adherence rate substantially exceeds the national benchmark of 31% of U.S. adults who report similar behaviors.

Respondents are not waiting for the market to fix this. Across multiple open-ended questions, the survey finds strong, consistent support for comprehensive government price controls — including negotiation, caps, and audits — with a clear preference for setting prices based on production cost plus a modest profit margin rather than value-based or R&D-recovery models.

The findings land at a pivotal moment: Medicare drug price negotiations under the Inflation Reduction Act took effect in January 2026, and a May 2025 executive order revived Most-Favored-Nation pricing proposals. Public pressure, this survey suggests, is running well ahead of policy.

Context

The Drug Price Survey collected 202 responses across five questions — one multiple-choice concern rating, one multi-select behavioral inventory, and three open-ended policy opinion questions. The survey was fielded online and drew respondents who, by their participation, likely have a heightened personal or civic stake in prescription drug pricing. That self-selection matters: it means the sample skews toward individuals with direct experience of drug cost hardship, which explains why concern and non-adherence rates run well above national averages.

The timing of this survey is significant. The policy landscape around drug pricing shifted meaningfully in 2024 and 2025. The Inflation Reduction Act's Medicare price negotiation provisions produced their first round of negotiated prices — covering 10 drugs — with those prices taking effect in January 2026 and projected to save the federal government $6 billion while cutting $1.5 billion in out-of-pocket costs for Medicare enrollees. In May 2025, President Trump signed an executive order reviving Most-Favored-Nation pricing, directing that U.S. drug prices align with the lowest prices paid by comparable nations. The Supreme Court, in a May 2026 ruling, declined to hear pharmaceutical industry challenges to Medicare negotiations, cementing the program's legal standing.

These developments form the backdrop against which respondents' opinions should be read. The survey captures public sentiment at a moment when government intervention in drug pricing has moved from campaign promise to enacted policy — yet the scale of that intervention remains limited relative to the breadth of the affordability problem. U.S. drug prices average 278% of prices in comparable countries, and brand-name originator drugs reach 422% of international prices before rebates, according to RAND Corporation analysis of 2022 data.

For the 50% of Medicare beneficiaries who report worrying about affording prescription drugs in 2026, and for the broader working-age population navigating high deductibles and formulary restrictions, the question is no longer whether prices are too high — it is how fast and how far policy will move to address them.

Findings

Nearly Eight in Ten Americans in This Survey Are Worried — and Nearly Half Are Desperate

The top-line affordability number is striking on its own: 77.6% of respondents say they are at least "somewhat concerned" about affording prescription drugs. But the intensity beneath that figure is what sets this survey apart. Forty-four percent describe themselves as "very concerned" — a share roughly double the 22% "very worried" figure in KFF's nationally representative March 2026 poll, which itself was a record high.

Only 7% of respondents say they are "not at all concerned." That near-unanimous worry, even among those who are not currently taking prescription medications, signals that drug affordability has crossed from personal hardship into a broadly shared civic anxiety. When the least-concerned group in a survey is still a sliver of the sample, the issue has reached saturation.

Skipping Doses, Skipping Refills: Cost Is Changing Medical Behavior

Concern becomes consequential when it changes what people actually do with their medicine. Among respondents who take prescription medications, the survey documents a pattern of cost-driven non-adherence that runs far ahead of national norms.

Twenty-four percent decided not to refill a prescription because of cost. Twenty-one percent skipped doses. Seventeen percent substituted a cheaper prescription. Only 21% of respondents who take prescription pills reported none of these behaviors — meaning that for most people in this sample who are on medication, cost has already forced a clinical compromise.

For context, a 2023 Statista/KFF nationally representative survey found that 31% of all U.S. adults had done at least one of these behaviors. The comparable share in this survey, among prescription-taking respondents, is roughly twice that. The gap reflects both the self-selected nature of this sample and the accelerating severity of drug cost pressure.

The connection between anxiety and action is direct and measurable. Respondents who describe themselves as "very concerned" about affordability are 76% more likely to have skipped doses or declined to refill a prescription compared to less-concerned respondents. Financial distress is not a passive feeling here — it is a predictor of medical risk.

A separate psychographic signal reinforces this pattern: respondents who score higher on the OCEAN personality trait of neuroticism are significantly more likely to report cost-driven medication behaviors, consistent with clinical literature linking neuroticism to reduced medication adherence across chronic conditions including diabetes and hypertension.

Respondents Want the Government to Set Prices — Comprehensively

Across three separate open-ended questions, respondents return to the same conclusion: the government should intervene in drug pricing, and that intervention should be broad, not narrow.

On the question of how drug prices should be regulated, respondents lean clearly toward comprehensive government price controls — including negotiation, caps, and audits — rather than market-driven alternatives. The preference is not close to neutral; statistical testing confirms a strong directional signal toward the most interventionist options.

When asked directly whether they support government intervention to force specific prescription costs, respondents again lean toward yes — and toward universal, unconditional intervention rather than drug-by-drug or condition-by-condition targeting. A meaningful minority does express conditional or skeptical views, creating a polarized rather than uniform distribution on scope, but the center of gravity sits firmly on the intervention side.

This aligns with national polling showing 72% of Americans believe there is insufficient government regulation of drug prices, with bipartisan supermajorities — 68% of Republicans, 72% of independents, 77% of Democrats — favoring more oversight. On allowing Medicare to negotiate drug prices specifically, national support reaches 85% of voters across party lines.

The Public Has a Specific Pricing Model in Mind

Respondents are not just demanding lower prices — they are describing a particular mechanism. When asked how prices should be set, the survey's dimensional analysis finds a clear lean toward production-cost-plus pricing: set the price based on what it costs to manufacture the drug, then add a modest profit margin.

This preference ranks ahead of value-based pricing (which ties price to clinical outcomes), R&D-recovery pricing (which factors in research investment), and international reference pricing (which benchmarks to peer countries). The production-cost model reflects a fundamental skepticism about pharmaceutical profit motives — a skepticism that appears in the open-ended responses, where respondents describe CEO compensation and shareholder returns as disconnected from the cost of getting medicine to patients.

Academic research supports the underlying grievance: high U.S. drug prices are not a market inevitability but a policy choice, one that prioritizes profit maximization for shareholders over health equity and access.

Respondents also prefer uniform pricing — the same price for every patient — over income-adjusted or means-tested models. This preference for simplicity may reflect distrust of complex subsidy systems, or a belief that systemic price reduction is more durable and equitable than individualized financial assistance. Whatever the motivation, it suggests the public wants prices fixed at the source, not patched at the point of sale.

Conclusion

The picture this survey draws is of a public that has already made up its mind. Affordability anxiety is pervasive, non-adherence is widespread, and support for government intervention is not a soft preference — it is a demand backed by lived experience.

The policy window is open but narrow. Medicare's first round of negotiated drug prices took effect in January 2026 covering just 10 drugs. The Most-Favored-Nation executive order remains in early implementation. These are meaningful steps, but they are orders of magnitude smaller than the structural reform this survey's respondents are describing when they call for production-cost-plus pricing across all prescription drugs.

Three things to watch in the months ahead: First, whether the Medicare negotiation program expands to its full statutory scope — potentially covering hundreds of drugs by the late 2020s. Second, whether MFN pricing survives legal and diplomatic challenges and translates into measurable price reductions for non-Medicare patients. Third, whether the IRA's 2024 out-of-pocket cap for Medicare Part D enrollees reduces the cost-driven non-adherence rates documented here.

For anyone tracking drug pricing policy or public health outcomes, the signal from this survey is unambiguous: the public is not waiting for the pharmaceutical industry to self-correct. They want a system overhaul — and they want it now.