New Survey Reveals Insurance Design Leads to Access and Affordability Issues for Most Vulnerable Patients

3 in 10 Americans That Have Insurance Still Face a Financial Barrier to Care

WASHINGTON, D.C. (October 7, 2021) – Patients with serious chronic diseases report major challenges in getting the right medication because of insurance practices that force them to fail on less expensive medications first, and minority populations suffer disproportionately, according to a new survey by PhRMA examining barriers people face in accessing health care and prescription medicines.

This and other key findings are detailed in Barriers to Health Care Access in the Patient Experience, the first survey in a series launched by the Pharmaceutical Research and Manufacturers of America (PhRMA) to explore the barriers people face in access to health care and prescription medicines. The new survey of nearly five thousand individuals, including more than 3,500 people who rely on prescription medicines, also finds 3 in 10 Americans that have insurance still face a financial barrier to care, like having trouble paying medical bills or having out-of-pocket costs that are more than they can afford.

“For too many Americans, insurance coverage is not providing the health security it’s meant to for the sickest and most vulnerable Americans,” said Stephen J. Ubl, president and chief executive officer of PhRMA. “This in-depth patient survey reveals a system where too often insurance policies and practices create barriers to life-saving care, leading patients to abandon medicines prescribed by their doctors. This has devastating results, including worse health outcomes for patients and higher costs throughout the health care system.”

Other key findings from the survey include:

  • Americans report difficulty paying out-of-pocket costs, such as deductibles and coinsurance, which can lead people to abandon their medicines. These costs are strongly related to whether individuals adhere to prescription medicines as prescribed by their doctor. Those most likely to be affected by adherence challenges are Americans who have medical debt.
  • Health plan use of tools like prior authorization or failing first on other therapies can create significant barriers to care – especially for the sick and people of color. The data show that these tools insurers use are associated with adherence challenges. Patients with some of the most serious chronic diseases — autoimmune diseases (62%), allergies (52%) and diabetes (52%) — are also more likely to report experiences with utilization management than other Americans who take prescription medicines. And disparities exist; while majorities of Black Americans (56%) and Hispanic Americans (60%) report being subject to utilization management practices, only 36% of white Americans report experiencing the same.
  • Roughly 40% of Americans say the coronavirus pandemic has made them more worried and anxious about their family’s ability to access care.
  • The survey finds Americans prioritize lowering costs at the pharmacy counter – further emphasizing the importance of health insurance benefit design that works better for patients. When asked to choose which they prefer, a majority of adults with insurance coverage prefer paying lower out-of-pocket costs (59%) compared with paying lower premiums (41%) each month.

PhRMA’s Stephen Ubl continued, “Missing from the current health care debate are any reforms that will help address structural problems many patients say they face in the health care system today. This survey shows that policymakers should focus on the real problems patients are experiencing by advancing solutions that address health care inequities, lower out-of-pocket costs and remove barriers to care.”

View the full analysis here.

About the Patient Experience Survey

PhRMA’s Patient Experience Survey (PES) is a new 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 findings are a result of the lived experiences of 4,765 Americans, including 3,612 who rely on prescription medicines. 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 would make a meaningful difference.

The inaugural PES was conducted online from June 25 – July 9, 2021. The full methodology can be found in the report.


About PhRMA

The Pharmaceutical Research and Manufacturers of America (PhRMA) represents the country’s leading innovative biopharmaceutical research companies, which are devoted to discovering and developing medicines that enable patients to live longer, healthier and more productive lives. Since 2000, PhRMA member companies have invested more than $1 trillion in the search for new treatments and cures, including $91.1 billion in 2020 alone.