Despite having health insurance, a significant number of Americans face financial barriers to accessing care and drugs, according to a recent survey by the nation’s largest pharmaceutical lobbying group.
Pharmaceutical companies have often come under fire for high drug costs. But the survey, commissioned by Drug Research and Manufacturers of America (PhRMA), pointed to insurers’ practices, such as usage management and cost-sharing with patients.
“To address affordability and accessibility challenges, policymakers must understand the deep-seated systemic barriers that insurers impose on patients,” PhRMA wrote in the survey, titled “Covered but still exposed: Barriers to caring for insured Americans. It was published in March and is a follow-up to the first survey, which was published in 2021.
The survey shows that some of these challenges stem from the burden of out-of-pocket costs, such as co-pays, coinsurance and high deductibles.
The survey, conducted in late 2021, found that 37 percent of Americans with health insurance experience financial barriers to care, with the burden disproportionately falling on women and people of color. Of those facing barriers, 63% were women and 51% reported having a chronic disease.
Overall, just over half (52%) of people with insurance believe they can cover additional out-of-pocket costs for a major medical event or a chronic disease diagnosis, the survey showed.
But more than a quarter, or 29 percent, said they would have to tap into savings or use a credit card to pay for extra costs, and a fifth or 19 percent said they would struggle to cover those costs.
Shares go up when divided by race and ethnicity. Nearly a quarter of black Americans, or 24 percent, said they would not be able to afford unexpected care costs. That figure is 21 percent for Hispanics and 17 percent for white Americans.
The survey also shed light on the challenges people face in practices such as prior authorization and step-by-step therapy — two forms of utilization management that have long been criticized by the pharmaceutical industry. Prior authorization is the need for approval from an insurance company before starting a medication, medical procedure, or diagnostic test/imaging. Ladder therapy requires the patient to try the drug preferred by the insurance company rather than the prescribing doctor. Insurance companies will only cover the original drug if the replacement fails.
According to the survey, nearly half (49%) of insured people taking prescriptions face some kind of insurer-imposed hurdle. Prior authorization was the most common, with an impact rate of 31%, followed by prescription non-coverage at 29%. Nearly a quarter, or 24 percent, said their insurer required a different prescription from what their doctor thought was the most effective drug.
Like costs, these barriers disproportionately affect people of color, with 64% of Hispanics, 55% of Blacks and 55% of Asian Americans reporting barriers. The figure for white Americans is 44%.
The survey noted that these barriers may pose health risks. People fail to follow their prescribing guidelines for a variety of reasons. But the survey found a correlation between prescription non-adherence and use management: Three-quarters of those who reported at least one incident of non-adherence said they were subject to some form of use management.
Not surprisingly, Americans are interested in finding some relief. Given a choice, two-thirds, or 66%, said they would prefer lower out-of-pocket costs than lower premiums when it comes to prescription drug coverage.
Specific reforms supported by respondents include requiring hospitals and Medicare Part D plans to pass discounts and rebates on prescription drugs directly to patients, as well as giving insurers more incentives to lower out-of-pocket costs.
The survey was conducted between November 30 and December 21. It includes responses from 4,264 Americans with health insurance.
