Out of control prescription drug prices have become something of a national scandal in the United States. As the cost of some of the most commonly prescribed and life saving medications continues to grow exponentially at as much as five times the rate of inflation, millions of Americans are faced with having to make difficult sacrifices in order to get the medication they need.

The health risks and medical repercussions of expensive and unaffordable prescription drugs are fairly obvious, but there are a number of lifestyle and economic impacts as well that affect individuals, families, and the communities where they live. According to the results of a Gallup Poll, Americans have borrowed upwards of $88 billion to cover medical expenses and treatments.

In addition to skipping medical care and medications because they’re too expensive, many Americans live in fear of going bankrupt if faced with a medical emergency or illness. Even people with six-figure salaries, well above the national median income, admitted to living in fear of personal bankruptcy in the event of a medical emergency or illness, and it’s not hard to understand why.

According to government data, Americans spend over $3 trillion on healthcare related costs, or over $10,000 per person. Healthcare spending in the United States accounts for nearly 18% of gross domestic product (GDP), and has increased 18.9% in the last five years alone.

To make matters worse, healthcare related expenses and the fear of losing everything in the face of an unpredictable medical emergency are only part of the problem. While they may not be the focus of debate when it comes to expensive prescription drugs and astronomical healthcare costs in the United States, here are some of the indirect effects that are punishing millions of American individuals and families.

Delaying or Putting Off College

The student loan crisis has grabbed headlines in recent years, crushing a generation of American students under insurmountable debt. What is often less discussed is the relationship between college tuition, which is already out of reach and unaffordable for so many students and their families, and the rising costs of healthcare. Even students already insured under a family healthcare plan may still be required to purchase additional health insurance through their university, which can add thousands of dollars to their yearly tuition bill.

And that’s just for healthy people with little to no outstanding medical debt or conditions that require prescription medications for short- or long-term treatment. As The New York Times revealed in a profile of several students struggling to meet the financial demands of an education, even medical students at Harvard University are faced with the crushing expenses associated with education and healthcare in the United States, which often go hand in hand:

As soon as Mr. Johnson began medical school classes, the costs began to pile up...Mr. Johnson worked at a Harvard cancer lab just before starting medical school. He sublet his apartment and slept on the medical school campus for several months so he could send his parents the money for a down payment on their home. He had a complication from a knee surgery but delayed visiting the hospital for weeks. The nurses were dismayed to see that a medical student had put off seeking treatment, as he struggled to explain that he could barely cover the bill.

Students from lower income backgrounds are especially at risk of being priced out of an education due to soaring tuition and healthcare costs.

A Vicious Cycle

Without a college education, Americans obviously struggle to find the kind of jobs that will pay an adequate salary, offer professional fulfillment and opportunity — and provide the employer sponsored healthcare plans that the majority of Americans rely on for medical treatment and to cover their prescription medications.

According to The Commonwealth Fund, over 150 million Americans (nearly half) under the age of 65 rely on their employer for health insurance and prescription drug coverage.

Pushing Back or Postponing Retirement

On the other end of the spectrum, many older Americans are delaying retirement due to their fears and worries about how they will pay for medical expenses and prescription drugs.

The need (and cost) of medical care and prescription medications generally tends to increase with age, and the average price tag for health-related expenses will make anyone think twice before deciding to take a chance on retirement. According to Forbes:

In The Lifetime Medical Spending of Retirees report, the economists determined that people incur an average of $122,000 in medical costs between the time they're 70 and when they die — mostly paid out-of-pocket, except for low-income people covered by Medicaid.

Some people over 70 face substantially higher costs, however, the study found. 5% will be hit with out-of-pocket medical bills of more than $300,000; 1% will see theirs total more than $600,000.