Every day at the pharmacy counter of Offa Specialist Hospital in Kwara State, North-Central Nigeria, a quiet crisis unfolds at the cash register. It starts with the soft rustle of paper—a prescription slip carrying a long, daunting list of life-sustaining medications. Then comes the pause. A patient checks their wallet and makes an impossible choice: Which of these five pills can I afford to take this month?

Behind our newly published study lies a stark reality about the human and economic toll of multi-drug therapy in resource-limited settings. While multi-drug regimens are often clinically necessary for managing chronic conditions, their benefits routinely collide with financial realities where healthcare depends on out-of-pocket spending.

Key Findings from the Field

• High Prevalence: Of 2,000 reviewed prescriptions, 0% met the criteria for polypharmacy (≥5 drugs), with 12.0% involving excessive polypharmacy (≥10 drugs).
• Severe Financial Strain: 37% of surveyed patients spend over ₦20,000 monthly on drugs, and 79% report that medication costs pose a significant financial burden.
• Compromised Adherence: 66% of patients admitted to skipping doses, reducing intake, or delaying drug purchases due to cost, while 78% required financial help from family or friends to buy their medicines.
• Provider Consensus: 84% of surveyed healthcare workers frequently encounter polypharmacy, 100% agree it escalates treatment costs, and 72% believe many regimens could be safely streamlined through structured medication reviews.

Moving Toward Solutions

Prescribing a drug is only half the therapeutic equation; ensuring the patient can afford to take it completes the cycle. Mitigating unnecessary polypharmacy in low- and middle-income countries requires three key strategies:

1. Routine Medication Reviews: Integrating pharmacist-led audits to optimize drug regimens and initiate safe deprescribing.
2. Health Insurance Expansion: Broadening universal coverage to protect households from catastrophic out-of-pocket expenses.
3. Multidisciplinary Care: Fostering teamwork among physicians, pharmacists, and clinical pharmacologists to enforce cost-effective, evidence-based prescribing.