New Report Exposes Critical Gaps in US Medication Affordability Infrastructure
A new report from RxUtility reveals that the US health care system is failing to capitalize on billions of dollars in available prescription savings, leaving patients to shoulder unnecessarily high medication costs. The report, “Healthcare is Losing the Fight for Medication Affordability,” details how a lack of integration and visibility in the prescription ecosystem is preventing patients from accessing over $30 billion in annual manufacturer copay assistance.
Despite the scale of available financial support, RxUtility’s analysis found that fewer than 10% of copay coupons are ever redeemed. The result is an estimated $27 billion in unused assistance each year—resources that could directly offset the growing out-of-pocket burden faced by patients managing chronic and complex conditions.
According to the report, “For the first time in U.S. history, there are four different prescription prices available to consumers,” illustrating a fragmented and opaque pricing environment that undermines affordability efforts. This new multi-price landscape includes retail cash prices, insurance-negotiated prices, manufacturer copay coupon prices, and third-party cash discount prices. Each represents a distinct—and often poorly understood—pathway to medication access, making it difficult for patients and clinicians to identify the lowest available cost at the point of care.
When applied, these programs are highly effective: RxUtility data shows that copay coupons can cover as much as 85% of a drug’s total cost. Yet in most cases, patients, pharmacists, and prescribers remain unaware of their availability because this information is not integrated into existing prescribing or dispensing technologies.
Among the therapeutic areas most affected are cancer, dermatology, diabetes, women’s health, and mental health—conditions often associated with high-cost, long-term medication regimens. Without real-time visibility into copay options, patients are frequently left to navigate affordability on their own, risking medication non-adherence due to financial strain.
The report calls for immediate investment in connected infrastructure that embeds affordability tools directly into clinical and pharmacy workflows. RxUtility argues that technology-enabled visibility—through price transparency tools, automated coupon applications, and lowest-cost comparisons—can transform how affordability information is shared and acted upon.
For health care executives and business leaders, the implications are significant. Integrating real-time affordability data into electronic health record (EHR) and pharmacy management systems could not only improve patient adherence but also reduce administrative friction, enhance satisfaction, and align with value-based care objectives. As the market continues to emphasize patient-centered care and cost transparency, RxUtility’s findings underscore the business and clinical imperative of embedding affordability intelligence into every stage of the prescribing process.
RxUtility, a health care technology company focused on making medications affordable for consumers, concludes that the solution lies in interoperability and automation. Without structural integration between manufacturers, payers, providers, and pharmacies, the system will continue to leave billions in savings untapped—at the expense of patient health and financial well-being.
Reference
- New Report from RxUtility: The U.S. Healthcare System Is Losing the Fight for Medication Affordability. Business Wire. October 21, 2025. Accessed October 21, 2025. https://www.businesswire.com/news/home/20251021175733/en/New-Report-from-RxUtility-The-U.S.-Healthcare-System-Is-Losing-the-Fight-for-Medication-Affordability
- Healthcare Is Losing the Fight for Medication Affordability. RxUtility. October 21, 2025. Accessed October 21, 2025. https://rxutility.com/Healthcare-Is-Losing-the-Fight-for-Medication-Affordability
