July 24, 2023 – Consumers disagree that insurers are protecting them from high out-of-pocket costs and believe usage management practices, such as prior authorization and form exclusions, are to blame for delays in accessing care and medications, according to a survey commissioned by Pharmaceutical Research and Manufacturers of America (PhRMA).

“As policymakers evaluate possible reforms to the U.S. healthcare system, leaders should consider the systemic barriers Americans face when navigating their coverage,” the survey explained. “An in-depth understanding of the patient experience will help deliver solutions that address patients’ real pain points and protect their access to innovative, life-saving medicines.”

PhRMA’s partner in this survey, Ipsos, reached out to more than 5,000 Americans between April 4 and April 17, 2023 to ask them to complete an online questionnaire. Of those surveyed, more than 3,440 reported taking prescription drugs and more than 4,820 said they were insured.

When it came to protecting them from high out-of-pocket costs, Americans weren’t convinced that payers were doing their job.

Just over a third of policyholders surveyed agree that insurance facilitates access to affordable care for all, and nearly 20% predict they would be unable to afford their healthcare costs if they developed a chronic illness or experienced an unexpected medical event (19%).

Respondents blamed use management practices such as prior authorizations and form requirements for delaying access to care and driving up costs. One in five participants had been banned from the form (20%) and slightly more than that had experienced previous authorizations (22%).

More than a third of chronically ill insured respondents who take medications have experienced usage management practices (36%). The share was even higher for respondents with neurological disorders and mental health needs.

Most participants agreed that insurers should not be the entity that assesses whether a drug is clinically appropriate (93%). They preferred suppliers to fill this role. Additionally, participants largely supported transparency and hospital oversight of drug discounts (92%) and that Congress should take action to better regulate insurers’ prescription drug coverage (92%).

Of the insured respondents, 747 were in medical debt (17%). Most respondents said the bills contributing to their debts were hospital or medical bills (59 and 57%, respectively). Additionally, 42% of respondents indicated that the cost of diagnostic tests contributed to their debts.

Policyholders in the LGBTQ+ community, Hispanics, health care professionals, and rural Americans had the highest rates of unaffordable out-of-pocket health care expenses. Among rural Americans, nearly four out of ten found their out-of-pocket health care spending unaffordable, despite having health insurance coverage (38%).

Direct healthcare spending was the top concern for respondents. Nearly six out of ten survey participants expressed concern about these costs (57%). By comparison, less than half of Americans were concerned about healthy food and transportation costs (45% and 40%, respectively).

Three health issues were top priorities for most of the respondents. When faced with a list of different health issues, including access to mental health care and the cost of prescription medicines, nearly a third of respondents said out-of-pocket health care costs were their top priority (32%), followed by premium costs (26%) and health system inefficiency (19%).

The policies listed in the survey that garnered the most support included policies that made health care spending more predictable, required insurers’ reimbursements to be passed on to patients in the form of discounts on prescription drugs, and reduced the negative effects of accumulator adjustment programs.

Other potential solutions to support low-income and uninsured patients that the survey highlighted included requiring that discounts on prescriptions go to low-income and uninsured patients and linking them to resources like the 340B program.