According to the Partnership to Fight Chronic Disease, 7.7 million Pennsylvanians live with at least one chronic health condition, such as diabetes, asthma, heart failure, hypertension, or high cholesterol. Yet an alarming number of people don’t take the medications prescribed by their health care provider to manage those conditions.

According to a study published in the Annals of Internal Medicine, 1 in 3 patients nationwide fail to fill first-time prescriptions. Another study in the same journal found that 50% of medications to manage chronic disease are not taken as prescribed.

Taking the wrong amount of prescribed medication—or not taking it at all—can bring serious consequences. “If a chronic health condition isn’t properly managed, people increase their risk for hospitalization,” said Maria Mulder, manager of outpatient pharmacy services at Penn State Health Milton S. Hershey Medical Center.

They also risk developing life-threatening health complications. Not taking blood pressure medicine correctly could lead to a stroke. Failing to take cholesterol medication as prescribed could lead to a heart attack. Taking the wrong amount of asthma medication could lead to a stressful visit to the emergency department.

And when it comes to diabetes, “I’ve seen patients’ blood sugar levels fall to near-fatal levels when they didn’t take their insulin correctly,” said Michele Haydo, clinical specialist for ambulatory care at the Milton S. Hershey Medical Center.

Costs rank high as a reason why people don’t take their medications. Some, including insulin, can be expensive, especially for people living on fixed incomes. “People on Medicare may fall into the ‘donut hole,’ which means they are responsible for a percentage of the cost of their drugs until they reach a certain dollar amount, and they struggle to pay those out-of-pocket costs,” Mulder said.

Drug costs also affect younger people who may be responsible for a co-pay and a portion of their deductible early in the year. To cut costs, some patients may take half a prescribed dose so their prescription lasts twice as long. “But if they don’t tell this to their provider, and their health condition doesn’t improve, they may get prescribed a higher dose, which could then put them at risk for negative side effects,” Haydo said.

Other reasons for not taking prescription medication include a lack of understanding about a medication or a health condition. Also, some people stop taking certain medications when they don’t notice a significant health change. “But with high blood pressure and cholesterol medicine, you don’t feel any different until you have a problem,” Mulder said.

To overcome these barriers, “start by being honest with your provider or pharmacist,” Haydo said. People should speak up when they don’t understand a prescribed medication or their health condition, or when they’re feeling overwhelmed by that information.

People also should speak up when they can’t afford their medications. The doctor or pharmacist may be able to find a more affordable medication that’s just as effective. Other options include:

Several options also exist for people who want to take their medications but sometimes forget a dose. For younger adults, pill reminder apps can send a daily notification to a smartphone. “For others, a daily pill box will organize medication by day of the week so people don’t miss a dose,” Mulder said.