Prescription Abandonment: The Patient Shouldn’t Have to Tell the Office
When a new prescription gets stuck, insurance tasks and the price of a first fill fall on patients and the family members who help them. The office they turn to can help sooner when it already knows what happened.
A man stops at the pharmacy on his lunch break to pick up his mother’s new prescription. The price is more than either of them expected, and he is due back at work. He tells the pharmacist he will check with her doctor’s office, leaves without the prescription, and calls the office from the car. He reaches the voicemail and leaves a message.
About one in four insured adults said in 2023 that their plan had refused to cover a prescription they needed, or charged a very high copay for it, at some point in the past year.[1] Each of those people, or someone helping them, then had to decide what to do next.
Getting a prescription filled asks a lot of the patient
In a 2019 national survey of insured adults under 65, nearly three in four had done at least one administrative task for their care in the past year, from scheduling to billing to prior authorization. Nearly one in four had delayed or gone without care because of those tasks, about the same share that other surveys find put off care because of cost.[2]
After cost, prior authorization tops the list of burdens patients face in getting care. In a KFF poll from January 2026, 34% of insured adults named it the single biggest burden in getting care apart from cost, and 39% of insured adults with a chronic condition did.[3] In the same poll, 47% had a service, treatment, or medication denied or delayed by their plan in the past two years.[3]
The person handling the prescription is often a family caregiver
The United States has an estimated 63 million family caregivers. Over 40% of them handle medical tasks such as managing medications, and 7 in 10 also have a job.[4]
The man at the pharmacy has a lunch break, a job to get back to, and his mother’s prescription to sort out. A second trip to the pharmacy, or a call to her plan, is time he does not have. When the office calls back, he may be the one who answers—from work. He is also the one who will pass along the pharmacist’s explanation, as best he remembers it.
Price decides whether a first fill ends in prescription abandonment
Cost is one of the clearest drivers of prescription abandonment. In a study of more than 58,000 people with a new, insurer-approved prescription for HIV prevention medicine, 5.5% never filled it when it cost nothing, and 42.6% never filled it when it cost more than $500. A change from $0 to $10 alone doubled the share left unfilled.[5]
The prescriber often does not see what the patient will pay. In one health system’s primary care clinics, the patient’s cost was shown at prescribing in 1.3% of eligible visits when the clinician had to open the tool and in 13.5% when the tool opened on its own.[6]
Help with cost exists, and which help fits depends on the patient’s plan. Manufacturer copay assistance was used on nearly a third of commercially insured brand prescriptions in the 10 largest therapy areas in 2023. Federal law bars manufacturers from offering copay coupons to people in federal healthcare programs such as Medicare and Medicaid, so other kinds of help apply to them.[7] Either way, someone has to know the patient needs help while the prescription is still at the pharmacy.
When something goes wrong, patients turn to their doctor’s office
In KFF’s 2023 survey, among insured adults who had a problem with their insurance in the past year, 53% contacted their insurer and 45% contacted their doctor or someone on the doctor’s staff. Another 22% took no action.[1] Most people trust their own doctor: 85% of adults said in January 2025 that they trust their own doctor a great deal or a fair amount.[8]
Michelle Keefe is a healthcare executive who has served as chief executive of Syneos Health and as a regional president at Pfizer and has led a range of efforts to improve patient care. She told us one thing has stayed largely true across decades: Patients “still respect their physician’s opinion and still see their physicians as an authority for their health.”
Across 94 studies, people were more likely to stay with a medicine when they believed they needed it and less likely when they had concerns about it.[9] A person who leaves a prescription at the pharmacy may also have a question about the medicine, and the office that wrote it can answer it.
Many people stop when the problem is not resolved
Among people in the 2023 survey whose insurance problem had not been resolved, 54% said they gave up.[1] In another national survey of insured adults, fewer than half of those denied care their doctor recommended said they or their doctor’s office appealed. Of those who did not, 45% were not sure they had the right to, and 40% did not know whom to contact.[10] Among insured adults with an insurance problem, those whose problem involved prior authorization were about three times as likely to say they could not get the care a provider recommended—34% compared with 10%.[11]
Some tried to sort out the problem and stopped when it stayed unresolved, and some never knew there was a next step. As Keefe put it, “Whether it’s a complicated journey or a simpler journey, if it doesn’t get filled, it’s the same outcome.”
The office can help when it knows what happened
When the office hears about a stuck prescription, the message often goes to a nurse, a medical assistant, or a prior authorization coordinator, who first works out the plan, the drug, and the reason for the problem. From there the office can start a prior authorization, send the brand’s support resource that fits the patient’s coverage, or raise it at the next visit. Sometimes the right step is a conversation because the patient has questions about the medicine or has decided to wait, and that decision belongs to the patient. The office can still make sure the patient knows what help exists. “Everybody in healthcare is in healthcare because they want to do the right thing for the patient,” Keefe said.
Each of those steps can happen sooner for the patient when the office already knows what happened at the pharmacy, the reason the plan gave, and where to send the patient for help. A voicemail from the car, as mentioned earlier, usually carries only part of what needs to be done. The office starts by calling back the man about his mother’s prescription, and the prescription waits at the pharmacy. If the callback reaches him at work, he must find his mother’s insurance card, remember what the pharmacist said, and call again later.
The office is where a brand’s support meets the patient
A prescription the plan approved but the patient never picked up is a lost start for the brand and its patient support program.
Much of the help a brand funds reaches the patient through the office: the prior authorization checklist, the hub enrollment, the copay program. The office can use it once it knows which patient is waiting and why.
How ReCaptRx™ reaches the office the patient already trusts
The patient should not have to be the one who tells the office.
When a prescription for the brand is rejected at the pharmacy or is paid by the plan but never picked up, ReCaptRx sends a notification to the prescriber’s office in near real time, through the channels the office already uses, with nothing to log into. It carries the reason the plan gave and the brand’s own support resource, such as a prior authorization checklist, a hub enrollment link, or a copay program. When the patient or the caregiver does call, the office already has both on hand.
Aventria Health Group takes its name from an avenue toward the Triple Aim, the Institute for Healthcare Improvement’s goal of a better experience of care for each person, better health for populations, and lower cost per person.[12] It has since been extended to a Quadruple Aim, with a fourth goal for the people who provide care, on the view that care of the patient requires care of the provider.[13] For the man in the car, a better experience of care is a call back from his mother’s doctor’s office that already knows what happened at the pharmacy and what help her plan allows.
References
Pollitz K, Pestaina K, Montero A, et al. KFF survey of consumer experiences with health insurance. KFF. June 15, 2023. Accessed October 14, 2026. https://www.kff.org/affordable-care-act/kff-survey-of-consumer-experiences-with-health-insurance
Kyle MA, Frakt AB. Patient administrative burden in the US health care system. Health Serv Res. 2021;56(5):755-765. doi:10.1111/1475-6773.13861
Kirzinger A, Montalvo J III, Hamel L. KFF Health Tracking Poll: prior authorizations rank as public’s biggest burden when getting health care. KFF. February 2, 2026. Accessed October 14, 2026. https://www.kff.org/public-opinion/kff-health-tracking-poll-prior-authorizations-rank-as-publics-biggest-burden-when-getting-health-care
AARP and National Alliance for Caregiving. Caregiving in the US 2025. July 24, 2025. Accessed October 14, 2026. doi:10.26419/ppi.00373.001
Dean LT, Nunn AS, Chang HY, et al. Estimating the impact of out-of-pocket cost changes on abandonment of HIV pre-exposure prophylaxis. Health Aff (Millwood). 2024;43(1):36-45. doi:10.1377/hlthaff.2023.00808
Kane RM, Morton-Oswald S, Lokhnygina Y, Maciejewski ML, Sloan CE. User-directed vs interruptive real-time benefit tools for medication changes in primary care. JAMA Netw Open. 2026;9(6):e2615767. doi:10.1001/jamanetworkopen.2026.15767
Long M, Salaga M, Pestaina K. Copay adjustment programs: what are they and what do they mean for consumers? KFF. October 24, 2024. Accessed October 14, 2026. https://www.kff.org/health-costs/copay-adjustment-programs-what-are-they-and-what-do-they-mean-for-consumers
Kearney A, Sparks G, Hamel L, et al. KFF tracking poll on health information and trust: January 2025. KFF. January 28, 2025. Accessed October 14, 2026. https://www.kff.org/health-information-trust/kff-tracking-poll-on-health-information-and-trust-january-2025
Horne R, Chapman SCE, Parham R, Freemantle N, Forbes A, Cooper V. Understanding patients’ adherence-related beliefs about medicines prescribed for long-term conditions: a meta-analytic review of the Necessity-Concerns Framework. PLoS One. 2013;8(12):e80633. doi:10.1371/journal.pone.0080633
Gupta A, Collins SR, Roy S, Masitha R. Unforeseen health care bills and coverage denials by health insurers in the US. Issue Brief (Commonw Fund). August 1, 2024. doi:10.26099/jqpw-jz55
Pollitz K, Pestaina K, Lopes L, Wallace R, Lo J. Consumer problems with prior authorization: evidence from KFF survey. KFF. September 29, 2023. Accessed October 14, 2026. https://www.kff.org/affordable-care-act/consumer-problems-with-prior-authorization-evidence-from-kff-survey
Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff (Millwood). 2008;27(3):759-769. doi:10.1377/hlthaff.27.3.759
Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med. 2014;12(6):573-576. doi:10.1370/afm.1713
