The Overlooked Fix for Drug Affordability? Give People More Time to Pay

The CDC estimates that 50% of prescriptions written are never filled or are taken incorrectly. For too long, we’ve focused on coverage and price as the primary path to affordability. But even good coverage and fair prices aren’t enough if the bill shows up before the paycheck. Time-to-pay is the missing piece that should be a standard of care for health plan design.

The connection between the cost of and adherence to critical medications is well proven. A 2017 study on delayed or unfilled oral anticancer prescriptions revealed a troubling trend: while 18% of prescriptions were abandoned in total, the rate increased to 41% for patients facing out-of-pocket costs between $501 and $2,000, and nearly half for those with costs exceeding $2,000.

The ability to pay the price affects patient decision making and has clinical (and financial) implications for employers and health plans to consider.

That’s why the findings from an April 2025 study by Penn Medicine are so significant. In 2023, patients with Medicare Part D coverage paid $11,000-$20,000 for oral anti-cancer drugs. By 2025, their cost is capped at $2,000. However, if patients opt into the Medicare Prescription Payment Plan (M3P), they can manage the $2,000 in 12 monthly payments of just $167. With the average social security check at $1,999, M3P makes these formerly inaccessible drugs much more affordable.

The “time-to-pay” concept is not limited to Medicare. It’s gaining traction in commercial health plans, offering similar relief to millions more.

• Alternative health plans: Some innovative plans are designed to pay healthcare providers in full upfront, then bill the patient for their out-of-pocket responsibility in installments.  
• Health Payment Accounts (HPAs): These accounts, often provided through partners, are increasingly popular with employer-sponsored and individual marketplace plans in numerous states. HPA cardholders can pay for medical expenses and convert them into interest-free repayment plans, often managed via payroll deduction or direct bank payments.

These models benefit everyone: patients gain access to needed care without crippling upfront costs, and providers are paid promptly and in full, which can reduce administrative burdens and potentially lead to payers negotiating more favorable rates. Time-to-pay isn’t just a financial fix; it’s one of the clearest paths to long-term cost sustainability in U.S. healthcare.

Yes, there should be efforts to lower drug prices overall. In the meantime, integrating time-to-pay options into health benefit design is becoming necessary. It’s a practical, proven way to expand access, improve affordability, and promote better outcomes.

To make healthcare more affordable in the short term and the long run, time-to-pay must become an essential component of every health plan with any out-of-pocket responsibility.  

Payers should integrate it into 2026 plan designs and proactively encourage enrollment. Providers should use it to help patients start (and stay on) essential therapies.

Photo: sorbetto, Getty Images

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