Key Trends: Patient experience data reveal how insurers and middlemen impose barriers in health care

The Patient Experience Survey (PES) series continues to reveal how health insurance is not working as it should for too many Americans — especially vulnerable groups. This series – including surveys of 5,000 Americans conducted with Ipsos, a leading research company in the United States — documents a consistent trend in reports of insurer- and middlemen-imposed practices that can keep patients from the medicines and treatments that they need.  

Key findings across PES surveys since 2021:

1. Out-of-pocket costs continue to drive health care affordability challenges for too many Americans.

Entering 2023, insured Americans identify out-of-pocket costs along with the cost of health insurance as the most important health care issues facing the country today. Furthermore, patients consistently cite high deductibles as the main reason it is difficult to afford their out-of-pocket expenses. And deductibles have consistently been the primary source of concern around affording health care. 

2. Barriers from insurers and middlemen like pharmacy benefit managers (PBMs) stand between patients and their medicines.

According to recent findings, 40% of insured Americans have trouble navigating their health insurance coverage. Research shows patients find their coverage confusing and are concerned about the constraints it could place on access to their medicines and treatments. In fact, according to findings reported in September 2022, 42% of insured Americans taking prescription medicines are concerned they would have to wait for their insurer to provide prior authorization for a medicine their doctor prescribes. And nearly half (47%) are concerned that a medicine their doctor recommended or prescribed wouldn’t be covered by their insurer (i.e., excluded from the formulary).

3. Disadvantaged groups are disproportionately affected by insurer- and middlemen-imposed barriers as well as affordability challenges.

Findings reported in February 2022 showed that Hispanic and Black Americans reported experiencing practices such as prior authorization and fail first policies significantly more than all insured Americans. Such disparities among disadvantaged populations are echoed when it comes to challenges affording care. According to the most recent PES research, women (19% vs. 15% men), Black Americans and Hispanic Americans (24% and 29%, respectively vs. 14% white Americans), and households with an annual income (HHI) of less than $75,000 (28% vs. 10% HHI more than $75,000) are more likely than insured Americans overall to report challenges affording their out-of-pocket costs.  

These trends are clear and so are Americans: Insured Americans favor policy solutions that require insurers and middlemen like PBMs to pass on savings directly to patients at the pharmacy counter and improve their health insurance coverage. To learn more about these solutions to address Americans’ true concerns, visit PhRMA.org/Middlemen. To follow trends in the patient experience, the first, second and third installments of the survey can be found here, here and here, respectively. For a summary of the latest Patient Experience data click here.

PhRMA’s Patient Experience Survey (PES) is a research initiative designed to explore the barriers patients face in accessing health care and prescription medicines. Launched in the wake of the coronavirus pandemic, which exposed many of the vulnerabilities of our health care system, the most recent survey reports the lived experiences of 2,097 Americans, including 1,945 with insurance. The survey was conducted December 14-29, 2022 by Ipsos using the probability-based KnowledgePanel®, the largest and most well-established online probability-based panel that is representative of the U.S. adult population. PES has also featured qualitative data from hours of in-depth interviews. The research aims to understand how patients engage with the health care system, uncover the real, practical challenges Americans face around access and affordability and identify solutions that could make a meaningful difference.