OBJECTIVES: To identify the clinical outcomes associated with self-perceived copay burden among patients with schizophrenia. METHODS: Data were taken from a nationwide survey of adults (age 18+) with a self-reported diagnosis of schizophrenia. The survey was fielded from December 2007 to February 2008. Data were collected through both self-reported questionnaires administered on-site, and via the Internet. Inclusion criteria for analysis were no exposure to clozapine, no use of a depot injection of an antipsychotic, and currently using a second generation antipsychotic (SGA). Outcomes included emergency room (ER) visits, hospitalization, suicide attempt, missed work (among employed patients), as well as experiencing severe distress defined as a score of 0-60 on the Psychological General Well Being (PGWB) scale. Assessment of the effects of self-perceived copay burden on outcomes was calculated using logistic regression models. Demographics, substance use, concomitant psychotropic medications, comorbidity, and health insurance were controlled for in the models. RESULTS: Of the patients who met the inclusion criteria (n=351), 39% (n=137) self-reported experiencing copay burden. Adjusting for covariates, patients who experienced copay burden were more likely to use the ER [OR=2.157; 95% CI:(1.322, 3.520); p=0.002], have a hospitalization [OR=2.512; 95% CI: (1.475, 4.277); p<0.001], have a suicide attempt [OR=2.385; 95% CI: (1.156, 4.920); p=0.019], and experience severe psychological distress [OR=1.833; 95% CI: (1.092, 3.075); p=0.022]. Among the 110 patients who were employed, those who experienced copay burden were more likely to have missed work in the past month [OR=7.193; 95% CI: (2.554, 20.256); p<0.001]. CONCLUSIONS: Among patients with schizophrenia using SGAs, greater copay burden was associated with increased ER visits, hospitalization, suicide attempts, missed work, and psychological distress. Patient's healthcare use and psychological well being are likely to benefit from less restrictive formularies that reduce copay burden for antipsychotic medication.