Many Americans Face Insurance Barriers to Healthcare Access
A new report reveals significant challenges insured Americans encounter with healthcare access and affordability, prompting calls for policy changes.
A November 2024 report, the Patient Experience Survey (PES 5) commissioned by the Pharmaceutical Research and Manufacturers of America (PhRMA), highlights substantial hurdles faced by Americans navigating the healthcare system.
The survey indicates that nearly half (41%) of insured Americans experienced at least one insurance-related barrier to healthcare access in the past year. Common obstacles included prior authorization requirements for prescribed medications and exclusion of drugs from insurance formularies. Patients with chronic conditions were disproportionately affected, jeopardizing their consistent access to necessary care.
Financial strain is also a major concern. Approximately half of insured individuals cannot anticipate the cost of their prescription medicines, and a similar number struggle to understand their health insurance coverage. Many fear future care denials by their insurers, with a significant portion reporting increased out-of-pocket expenses and medical debt. This underscores a need for greater predictability and affordability within insurance plans.
Public support is strong for increased accountability from insurance companies and Pharmacy Benefit Managers (PBMs). Measures gaining traction include requiring insurers to pass rebates and discounts directly to patients at the point of sale and cracking down on PBM practices like inappropriate "step therapy" mandates. Ensuring that manufacturer copay assistance counts towards patient deductibles also receives widespread backing.
Americans identify lowering healthcare costs, particularly out-of-pocket expenses and insurance premiums, as a top priority for policymakers. They expect elected officials to actively work towards ensuring access to and affordability of care, as well as promoting innovative and preventive treatments.