Some residents in American Samoa say they can't afford to pay their bill at the LBJ hospital.
Crowds of patients had swarmed to the hospital over the weekend to get medications before fees went up and enforced partial payment for outstanding bills became mandatory this week.
Since the hike, the pharmacy has had noticeably fewer customers as the price rose from US$10 to $40 per prescription.
An outpatient from the Philippines, who didnt want to be named, says he can no longer afford to get his medication for diabetes.
"They are charging me $181, plus the 10 percent of which I owe, which is $30. So that is about $210 for my medicine so I'd rather order it from my home country which costs only $50."
The LBJ Hospital board said it had to implement higher fees because of its financial problems, that stemmed from the government's failure to pay nearly half of the mandated subsidies in the last fiscal year.