Medication access and adherence are essential determinants of health outcomes. We investigated factors associated with access and cost‐related non‐adherence to prescriptions in a population‐based cohort of systemic lupus erythematosus (SLE) patients and controls. A structured interview collected detailed sociodemographic and prescription data in 2014‐2015 from participants in the Michigan Lupus Epidemiology & Surveillance (MILES) Cohort. We compared access between cases and frequency‐matched controls and examined associated factors in separate multivariable logistic regression models.

Six hundred fifty-four participants (462 SLE cases, 192 controls) completed the baseline visit; 584 (89%) were female, 285 (44%) black, and the mean age was 53 years. SLE cases and controls reported similar frequencies of inability to access prescribed medications (12.1% vs. 9.4%, respectively; p=NS). SLE patients were twice as likely as controls to report cost‐related prescription non‐adherence in the preceding 12 months to save money (21.7% vs. 10.4%; p=0.001) and more likely to ask their doctor for lower-cost alternatives (23.8% vs. 15.6%, p=0.02). Disparities were found in association with income, race, and health insurance status, but main findings persisted after adjusting for these and other variables in multivariable models.

SLE patients were more likely than controls from the general population to report cost‐related prescription non‐adherence, including skipping doses, taking less medicine, and delaying filling prescriptions, yet less than 1 in 4 patients asked providers for lower-cost medications. Consideration of medication costs in patient decision‐making could provide a meaningful avenue for improving access and medication adherence.