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The rising cost of prescription drugs raises the possibility of cost-related medication nonadherence. In a cross-sectional survey of 1506 adult patients at an academic emergency department in Philadelphia, 5% of patients reported concern about affording medications and an additional 20% reported they had not taken medications because of cost concerns. Significant risk factors for cost-related medication nonadherence were inadequate health insurance (relative risk, 7.7), financial instability (RR, 3.9), food insecurity (RR, 3.7), housing problems (RR, 2.5), illicit drug use (RR, 2.0), intimate partner violence (RR, 1.8), and tobacco use (RR, 1.8).