Prescription Abandonment: Why Patients Don't Fill Their Medications and What to Do About It
Prescription Abandonment: Why Patients Don't Fill Their Medications and What to Do About It
Tuesday, February 3, 2026
Tuesday, February 3, 2026
The Specialty Abandonment Crisis
Across all prescriptions, approximately 9% are abandoned - patients receive a prescription but never fill it. For most medications, that's a manageable loss.
For specialty medications, it's a different story entirely. Research from BrightInsight and Claritas Rx found that only 62% of specialty prescriptions result in a paid fill. Nearly 40% are never filled. When out-of-pocket costs exceed $500, IQVIA data shows abandonment rates hit 60%.
This isn't primarily a billing problem. It's a clinical problem. These are patients prescribed disease-modifying therapies for cancer, autoimmune conditions, and rare diseases who never start treatment. The downstream consequences - disease progression, hospitalization, worse long-term outcomes - are predictable and preventable.
What follows is a consolidation of the data on prescription abandonment, broken down by cause, with solutions mapped to each driver.
Across all prescriptions, approximately 9% are abandoned - patients receive a prescription but never fill it. For most medications, that's a manageable loss.
For specialty medications, it's a different story entirely. Research from BrightInsight and Claritas Rx found that only 62% of specialty prescriptions result in a paid fill. Nearly 40% are never filled. When out-of-pocket costs exceed $500, IQVIA data shows abandonment rates hit 60%.
This isn't primarily a billing problem. It's a clinical problem. These are patients prescribed disease-modifying therapies for cancer, autoimmune conditions, and rare diseases who never start treatment. The downstream consequences - disease progression, hospitalization, worse long-term outcomes - are predictable and preventable.
What follows is a consolidation of the data on prescription abandonment, broken down by cause, with solutions mapped to each driver.
The Numbers
This section pulls together abandonment statistics that are frequently cited but rarely found in one place.
Overall Abandonment Rates
Population | Abandonment Rate | Source |
|---|---|---|
All prescriptions | ~9% | IQVIA 2020 |
Specialty prescriptions | ~38% (62% paid fill rate) | BrightInsight + Claritas Rx |
Non-life-saving specialty drugs | 40-50% cluster | BrightInsight + Claritas Rx |
The gap between 9% (all prescriptions) and 38% (specialty) represents one of the largest opportunities in healthcare to improve patient outcomes through operational and technology intervention.
Abandonment by Out-of-Pocket Cost
Cost is the single strongest predictor. The relationship is linear and stark:
Out-of-Pocket Cost | Abandonment Rate | Source |
|---|---|---|
$0 (free) | ~5% | IQVIA 2020 |
$0-$50 | 1.3%-10% | JMCP 2023 |
$100+ | 32%-75% | JMCP 2023 |
$500+ | ~60% | IQVIA 2020 |
The implication is clear: reduce out-of-pocket costs, reduce abandonment. Financial assistance programs exist for exactly this purpose. The problem is enrollment.
Abandonment by Therapy Area
Some therapeutic categories see dramatically higher abandonment:
Therapy Area | Abandonment Rate | Source |
|---|---|---|
Oral oncolytics (cancer) | Up to 67% | JMCP 2023; Dusetzina et al. JCO 2018 |
Anti-inflammatory (autoimmune) | Up to 52.3% | JMCP 2023 |
General specialty average | ~38% | BrightInsight + Claritas Rx |
These rates reflect compounding factors: high costs, PA requirements, and patient-level barriers like fear of side effects and complex administration.
The Deductible Effect
Specialty therapy abandonment spikes during the deductible period - Q1 of each plan year, when out-of-pocket costs are highest. According to CoverMyMeds, this creates a predictable window of high abandonment risk when patient cost share hasn't yet accumulated toward annual limits.
The Copay Assistance Gap
Approximately $30 billion in manufacturer copay assistance is available annually. According to eMarketer, 93% goes unused.
Why the gap?
Patients don't know programs exist
Enrollment is complex and manual
Providers lack visibility into available programs
Programs exhaust funding without notification
This is one of the clearest intervention opportunities - connecting eligible patients with assistance that already exists.
The Accumulator Problem
Copay accumulators and maximizers are increasingly common plan designs that prevent manufacturer assistance from counting toward deductibles and out-of-pocket maximums. Per JMCP 2024:
39% of commercial beneficiaries are in plans with copay accumulators
41% are in plans with copay maximizers
These programs mean patients may face high costs mid-year when assistance exhausts but deductibles remain unmet - a second abandonment window beyond the deductible period.
This section pulls together abandonment statistics that are frequently cited but rarely found in one place.
Overall Abandonment Rates
Population | Abandonment Rate | Source |
|---|---|---|
All prescriptions | ~9% | IQVIA 2020 |
Specialty prescriptions | ~38% (62% paid fill rate) | BrightInsight + Claritas Rx |
Non-life-saving specialty drugs | 40-50% cluster | BrightInsight + Claritas Rx |
The gap between 9% (all prescriptions) and 38% (specialty) represents one of the largest opportunities in healthcare to improve patient outcomes through operational and technology intervention.
Abandonment by Out-of-Pocket Cost
Cost is the single strongest predictor. The relationship is linear and stark:
Out-of-Pocket Cost | Abandonment Rate | Source |
|---|---|---|
$0 (free) | ~5% | IQVIA 2020 |
$0-$50 | 1.3%-10% | JMCP 2023 |
$100+ | 32%-75% | JMCP 2023 |
$500+ | ~60% | IQVIA 2020 |
The implication is clear: reduce out-of-pocket costs, reduce abandonment. Financial assistance programs exist for exactly this purpose. The problem is enrollment.
Abandonment by Therapy Area
Some therapeutic categories see dramatically higher abandonment:
Therapy Area | Abandonment Rate | Source |
|---|---|---|
Oral oncolytics (cancer) | Up to 67% | JMCP 2023; Dusetzina et al. JCO 2018 |
Anti-inflammatory (autoimmune) | Up to 52.3% | JMCP 2023 |
General specialty average | ~38% | BrightInsight + Claritas Rx |
These rates reflect compounding factors: high costs, PA requirements, and patient-level barriers like fear of side effects and complex administration.
The Deductible Effect
Specialty therapy abandonment spikes during the deductible period - Q1 of each plan year, when out-of-pocket costs are highest. According to CoverMyMeds, this creates a predictable window of high abandonment risk when patient cost share hasn't yet accumulated toward annual limits.
The Copay Assistance Gap
Approximately $30 billion in manufacturer copay assistance is available annually. According to eMarketer, 93% goes unused.
Why the gap?
Patients don't know programs exist
Enrollment is complex and manual
Providers lack visibility into available programs
Programs exhaust funding without notification
This is one of the clearest intervention opportunities - connecting eligible patients with assistance that already exists.
The Accumulator Problem
Copay accumulators and maximizers are increasingly common plan designs that prevent manufacturer assistance from counting toward deductibles and out-of-pocket maximums. Per JMCP 2024:
39% of commercial beneficiaries are in plans with copay accumulators
41% are in plans with copay maximizers
These programs mean patients may face high costs mid-year when assistance exhausts but deductibles remain unmet - a second abandonment window beyond the deductible period.
Three Root Causes
Abandonment stems from three categories of barriers. Knowing which affects your patient population tells you where to focus.
Financial Barriers
Out-of-pocket costs are the largest driver. When patients face high costs, they don't fill.
Why costs are high:
Specialty drug average annual cost: $78,000 (CoverMyMeds 2020)
Coinsurance for specialty tiers can mean $500+ monthly for 6-7%+ of patients per drug (AJMC)
Accumulators and maximizers reduce the value of manufacturer assistance
Foundation funding is limited and often exhausts mid-year
What patients experience:
A patient gets a prescription for a specialty medication. At the pharmacy, they learn their out-of-pocket cost is $800 for a 30-day supply. They leave without filling. The prescription sits while they debate whether they can afford it - or they just decide to skip treatment entirely.
Solutions:
Proactive financial assistance screening at intake, before prescriptions reach the pharmacy
Automated copay card enrollment in the prescription workflow
Real-time benefit check at point of prescribing to surface costs before patients leave
Foundation grant matching and application assistance
Alternative therapy identification when lower-cost equivalents exist
Administrative Barriers (PA Delays, Coordination Failures)
Prior authorization delays are the second-largest driver. The 2024 AMA survey found 93% of physicians say PA delays care.
Where time is lost:
Determining if PA is required (hours to 1 day)
Gathering clinical documentation (1-3 days)
Submitting to payer (hours to 1 day if fax)
Payer review queue (2-10 days)
Responding to additional info requests (1-5 days)
Appeal if denied (5-15 days)
The coordination problem:
Specialty prescriptions involve 4-6 parties: patient, prescriber, payer, pharmacy, manufacturer, sometimes a hub. Communication failures, missing documentation, and routing errors create friction at every handoff.
What patients experience:
A patient receives a prescription. The specialty pharmacy calls to say PA is required. Days pass. No updates. They call the pharmacy, which says to call the doctor. The doctor's office says they're waiting on the payer. After two weeks of uncertainty, the patient assumes treatment isn't happening and moves on. They never start the therapy they were prescribed.
Solutions:
Electronic PA adoption
AI-powered PA automation
Streamlined referral intake with complete documentation upfront
Multi-channel patient communication with proactive status updates
Clear handoff protocols
For detailed PA strategies, see: How to Reduce Prior Authorization Delays.
Abandonment stems from three categories of barriers. Knowing which affects your patient population tells you where to focus.
Financial Barriers
Out-of-pocket costs are the largest driver. When patients face high costs, they don't fill.
Why costs are high:
Specialty drug average annual cost: $78,000 (CoverMyMeds 2020)
Coinsurance for specialty tiers can mean $500+ monthly for 6-7%+ of patients per drug (AJMC)
Accumulators and maximizers reduce the value of manufacturer assistance
Foundation funding is limited and often exhausts mid-year
What patients experience:
A patient gets a prescription for a specialty medication. At the pharmacy, they learn their out-of-pocket cost is $800 for a 30-day supply. They leave without filling. The prescription sits while they debate whether they can afford it - or they just decide to skip treatment entirely.
Solutions:
Proactive financial assistance screening at intake, before prescriptions reach the pharmacy
Automated copay card enrollment in the prescription workflow
Real-time benefit check at point of prescribing to surface costs before patients leave
Foundation grant matching and application assistance
Alternative therapy identification when lower-cost equivalents exist
Administrative Barriers (PA Delays, Coordination Failures)
Prior authorization delays are the second-largest driver. The 2024 AMA survey found 93% of physicians say PA delays care.
Where time is lost:
Determining if PA is required (hours to 1 day)
Gathering clinical documentation (1-3 days)
Submitting to payer (hours to 1 day if fax)
Payer review queue (2-10 days)
Responding to additional info requests (1-5 days)
Appeal if denied (5-15 days)
The coordination problem:
Specialty prescriptions involve 4-6 parties: patient, prescriber, payer, pharmacy, manufacturer, sometimes a hub. Communication failures, missing documentation, and routing errors create friction at every handoff.
What patients experience:
A patient receives a prescription. The specialty pharmacy calls to say PA is required. Days pass. No updates. They call the pharmacy, which says to call the doctor. The doctor's office says they're waiting on the payer. After two weeks of uncertainty, the patient assumes treatment isn't happening and moves on. They never start the therapy they were prescribed.
Solutions:
Electronic PA adoption
AI-powered PA automation
Streamlined referral intake with complete documentation upfront
Multi-channel patient communication with proactive status updates
Clear handoff protocols
For detailed PA strategies, see: How to Reduce Prior Authorization Delays.
Patient-Level Barriers and Who Pays the Price
Patient-Level Barriers (Confusion, Fear, Logistics)
Even when cost is covered and PA is approved, patients may not fill due to confusion, fear, or logistics.
Confusion:
Don't understand the diagnosis or why the medication was prescribed
Specialty pharmacy is unfamiliar - they don't know the process
Multiple parties contact them with conflicting information
Don't know what to do next
Fear:
Side effect concerns, especially for injectables, chemo, immunosuppressants
Fear of dependency or long-term treatment
Previous bad experiences with medications
Uncertainty about efficacy
Logistics:
Infusion center scheduling conflicts
Travel requirements for administration
Cold chain requirements for refrigerated medications
Transportation barriers
What patients experience:
A patient clears PA, gets copay assistance, and should be ready. But the specialty pharmacy's outreach call goes to voicemail. The patient doesn't recognize the number and doesn't call back. The prescription sits in queue. Eventually expires.
Or: the patient receives the medication but is terrified to self-inject. The training call was brief, they didn't absorb it. The medication sits in their refrigerator while they work up courage. Weeks pass.
Solutions:
Structured patient education at point of prescribing
Concierge onboarding with dedicated navigators
Proactive outreach via text, phone, and email at key milestones
Video-based injection training with follow-up support
Simplified scheduling for infusion and site-of-care appointments
Transportation assistance
Who Pays the Price
Abandonment creates costs for everyone in healthcare. Understanding the distributed impact helps build alignment for improvement.
Patients: Disease progression, hospitalization, worse long-term outcomes, continued symptoms when treatment could provide relief.
Providers: Lost revenue, quality metric impact, care gap documentation burden, clinical frustration when treatment plans don't execute.
Pharma manufacturers: Lost commercial revenue, worse real-world evidence, higher cost per patient start (when 60% fill, acquisition costs effectively increase 67%), poor hub program ROI.
Payers: Higher downstream costs from emergency utilization and disease progression, medical loss ratio pressure, quality program penalties, poor member experience.
Health systems: Readmissions, ED utilization, quality penalties, population health failure.
Patient-Level Barriers (Confusion, Fear, Logistics)
Even when cost is covered and PA is approved, patients may not fill due to confusion, fear, or logistics.
Confusion:
Don't understand the diagnosis or why the medication was prescribed
Specialty pharmacy is unfamiliar - they don't know the process
Multiple parties contact them with conflicting information
Don't know what to do next
Fear:
Side effect concerns, especially for injectables, chemo, immunosuppressants
Fear of dependency or long-term treatment
Previous bad experiences with medications
Uncertainty about efficacy
Logistics:
Infusion center scheduling conflicts
Travel requirements for administration
Cold chain requirements for refrigerated medications
Transportation barriers
What patients experience:
A patient clears PA, gets copay assistance, and should be ready. But the specialty pharmacy's outreach call goes to voicemail. The patient doesn't recognize the number and doesn't call back. The prescription sits in queue. Eventually expires.
Or: the patient receives the medication but is terrified to self-inject. The training call was brief, they didn't absorb it. The medication sits in their refrigerator while they work up courage. Weeks pass.
Solutions:
Structured patient education at point of prescribing
Concierge onboarding with dedicated navigators
Proactive outreach via text, phone, and email at key milestones
Video-based injection training with follow-up support
Simplified scheduling for infusion and site-of-care appointments
Transportation assistance
Who Pays the Price
Abandonment creates costs for everyone in healthcare. Understanding the distributed impact helps build alignment for improvement.
Patients: Disease progression, hospitalization, worse long-term outcomes, continued symptoms when treatment could provide relief.
Providers: Lost revenue, quality metric impact, care gap documentation burden, clinical frustration when treatment plans don't execute.
Pharma manufacturers: Lost commercial revenue, worse real-world evidence, higher cost per patient start (when 60% fill, acquisition costs effectively increase 67%), poor hub program ROI.
Payers: Higher downstream costs from emergency utilization and disease progression, medical loss ratio pressure, quality program penalties, poor member experience.
Health systems: Readmissions, ED utilization, quality penalties, population health failure.
Solutions Mapped to Causes
Root Cause | Solution | Who Implements | Technology |
|---|---|---|---|
Cost: unaware of assistance | Proactive screening at intake | Hub / patient services | Financial assistance automation |
Cost: copay too high | Automated copay card + foundation enrollment | Hub / pharmacy | FA platforms |
Cost: accumulator impact | Real-time benefit check + alternative programs | Hub / pharmacy | BV + FA integration |
PA delays: slow submission | Electronic PA / AI automation | Provider / hub | ePA platforms |
PA delays: documentation gaps | Pre-built templates by therapy | Provider | EHR templates + AI |
PA delays: denial cycle | Automated appeals | Hub / provider | PA automation |
Patient confusion | Structured onboarding with education | Hub / care team | Onboarding automation |
Patient fear | Nurse-led or AI-led counseling | Care team / hub | Care management |
Logistics | Concierge scheduling, home infusion | Hub / pharmacy | Patient communication AI |
Where to Start
If cost is your primary driver (high-cost specialty therapies): Financial assistance automation first. Integrate BV with FA screening. Track accumulator exposure.
If PA delays are your primary driver (high PA rate therapies): Electronic PA if still on fax. Evaluate AI-powered PA automation. Build documentation templates. See our ePA platform comparison.
If patient barriers are your primary driver (complex/injectable therapies): Invest in onboarding and education. Multi-channel outreach. Consider nurse navigator or concierge models.
Root Cause | Solution | Who Implements | Technology |
|---|---|---|---|
Cost: unaware of assistance | Proactive screening at intake | Hub / patient services | Financial assistance automation |
Cost: copay too high | Automated copay card + foundation enrollment | Hub / pharmacy | FA platforms |
Cost: accumulator impact | Real-time benefit check + alternative programs | Hub / pharmacy | BV + FA integration |
PA delays: slow submission | Electronic PA / AI automation | Provider / hub | ePA platforms |
PA delays: documentation gaps | Pre-built templates by therapy | Provider | EHR templates + AI |
PA delays: denial cycle | Automated appeals | Hub / provider | PA automation |
Patient confusion | Structured onboarding with education | Hub / care team | Onboarding automation |
Patient fear | Nurse-led or AI-led counseling | Care team / hub | Care management |
Logistics | Concierge scheduling, home infusion | Hub / pharmacy | Patient communication AI |
Where to Start
If cost is your primary driver (high-cost specialty therapies): Financial assistance automation first. Integrate BV with FA screening. Track accumulator exposure.
If PA delays are your primary driver (high PA rate therapies): Electronic PA if still on fax. Evaluate AI-powered PA automation. Build documentation templates. See our ePA platform comparison.
If patient barriers are your primary driver (complex/injectable therapies): Invest in onboarding and education. Multi-channel outreach. Consider nurse navigator or concierge models.
Measuring Abandonment
You can't improve what you don't measure.
Primary Metric: Paid Fill Rate
Definition: Prescriptions resulting in filled, paid claim ÷ Total prescriptions written
Benchmark: BrightInsight shows 62% average for specialty. Target improvement from your baseline toward this benchmark and beyond.
Supporting Metrics
Metric | Why It Matters |
|---|---|
Time from Rx to first fill | Longer timelines correlate with higher abandonment |
FA enrollment rate | Measures cost barrier mitigation |
First-pass PA approval rate | Higher = better documentation quality |
Patient outreach completion | Measures patient barrier mitigation |
Abandonment by reason | Enables root cause targeting |
Establishing a Baseline
Most organizations underestimate abandonment because they don't track it systematically.
To establish a baseline:
Pharmacy claims data: Compare prescriptions written to claims paid
Hub reporting: Request abandonment data from hub/patient services vendors
Specialty pharmacy reports: Prescriptions received vs. dispensed
EHR tracking: Some EHRs track prescription status through fill
Data sources won't align perfectly - prescriptions may be written but never sent, or filled at a different pharmacy. Reconciliation is imperfect but directionally valuable.
The Bottom Line
Prescription abandonment is the ultimate failure metric for patient access. Every abandoned prescription represents a patient who was prescribed treatment, went through the system, and never started therapy.
The causes are well-understood:
Financial barriers when costs are high
Administrative barriers when PA delays and coordination failures create friction
Patient barriers when confusion, fear, or logistics get in the way
The solutions exist. Financial assistance automation, electronic PA, AI-powered workflows, structured onboarding - all can address these causes. The question is execution.
For readers ready to evaluate specific solutions:
Electronic prior authorization platforms compared
How to reduce prior authorization delays
Sources:
• IQVIA Institute. "Medicine Use and Spending in the U.S.: A Review of 2018 and Outlook to 2023." 2020.
• BrightInsight and Claritas Rx. "Abandonment and Discontinuation Variation in Specialty Drugs." 2024.
• JMCP. "The Association Between Cost Sharing, Prior Authorization, and Specialty Drug Utilization." 2023.
• JMCP. "Copay Assistance Use and Prescription Abandonment." 2023.
• Dusetzina et al. "Out-of-Pocket Costs and Oral Anticancer Agent Prescriptions." Journal of Clinical Oncology, 2018.
• AJMC. "Cost Sharing for Oral Lenvatinib Among Commercially Insured Patients."
• CoverMyMeds. "2020 Medication Access Report: Specialty Patient Support."
• eMarketer. "Nearly $30B in Pharma Manufacturer Coupons Go Unused." 2025.
• JMCP. "Copay Accumulator and Maximizer Programs: A Primer." 2024.
• AMA. "2024 Prior Authorization Physician Survey." December 2024.
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@ 2025 Neon Health (Belay, Inc).
AI-powered patient access automation
for leading pharma enterprises.
NEWSLETTER
@ 2025 Neon Health (Belay, Inc).
AI-powered patient access automation for leading pharma enterprises.
NEWSLETTER
@ 2025 Neon Health (Belay, Inc).
AI-powered patient access automation
for leading pharma enterprises.