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Some With Health Insurance May Not Be Getting Their Money's Worth When it Comes to Affordable, Accessible Care


Results from a recent study reveal insured Americans believe health insurance is not living up to providing affordable and accessible healthcare.

In the fourth installment of the Patient Experience Survey (PES) from PhRMA/Ipsos, it was found coverage and affordability continue to fall short for many insured Americans who need access to care.

Conducted April 4 to 17 this year by Ipsos using the probability-based KnowledgePanel®, the survey is based on 5,152 adults aged 18 or older. The survey included 3,443 insured respondents who reported taking prescription medicines and 4,823 respondents who reported being insured.

Researchers designed the survey to explore the experiences and barriers patients face in accessing healthcare and prescription medicines.

Results reveal insured Americans believe health insurance is not living up to providing affordable and accessible healthcare. For example, many insured Americans worry insurance may not cover a medicine their doctor prescribes, and some report difficulty accessing medication because of insurance barriers. Out-of-pocket healthcare costs are also a significant concern for the insured.

Those in this category said they are more worried about their ability to afford their healthcare out-of-pocket costs (57%) than they are about expenses like the costs of healthy food (45%) or transportation (40%).

Other key findings in the survey include:

  • Nearly all insured Americans (93%) think insurance should provide affordable access to healthcare, as only a third (34%) think it currently does.
  • About four in 10 insured Americans taking prescription medication (38%) report that, in the past year, they or a family member had trouble accessing their medication because of various insurance barriers.
  • Specifically, three in ten (29%) insured Americans taking prescription medication note that, in the past year, they or their family members faced at least one utilization management practice, like waiting for their insurance to authorize a medicine their doctor prescribes.
  • Nearly all insured Americans (93%) agree doctors should determine whether a prescription medicine is clinically appropriate.

Data found participants believe potential solutions to combat these concerns can address out-of-pocket costs and insurance barriers.

Some of these solutions include ensuring more predictability in healthcare, so folks know how much they will pay for things such as prescription drugs every month.

  • Others include the 89% of insured Americans who support government policies aimed at requiring health insurers to pass on any rebates or discounts they receive from pharmaceutical companies on prescription drugs at the pharmacy counter, so patients pay less out of pocket for their medicines.
  • Most insured Americans (88%) support the government pursuing policies that prevent surprise out-of-pocket costs at the pharmacy and higher out-of-pocket costs that may be caused when an insurance company does not count copay assistance from a pharmaceutical company toward a deductible and annual maximum out-of-pocket cost.
  • A majority of insured Americans (87%) also support the government requiring hospitals to use the discounts they receive on prescription medicines to help low-income and uninsured patients access meds.
  • Lastly, (86%) of insured Americans back the government ensuring low-income patients benefit directly from safety net programs like 340B that provides hospitals with steep discounts on medicines.
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