Health care affordability is not the only hurdle facing patients, according to PhRMA’s third Patient Experience Survey (PES). The latest PES report exposes another crucial problem: the frustration and confusion people have around how to use their coverage. Administrative hurdles and other barriers imposed by health insurers and pharmacy benefit managers (PBMs), such as time-consuming paperwork or prior authorization, are a challenge for many insured Americans, including more vulnerable communities.
Here are ways that insurance barriers stand between patients and care, as well as Americans’ desired solutions:
1. Insurer- and PBM-imposed cost sharing continues to leave Americans financially vulnerable.
Consistent with our previous PES findings, too many insured patients report challenges with their out-of-pocket costs. Thirty percent of insured Americans face a financial barrier to care, such as difficulty affording their out-of-pocket costs or lacking savings to cover unforeseen expenses. And even with insurance, 15% report they would be unable to afford health care if they were to become seriously ill because of high out-of-pocket costs. Deductibles are the primary reason for those facing difficulty with their out-of-pocket costs; in fact, 36% cite their deductible as the number one factor.
2. Insured Americans are struggling to navigate their coverage.
On top of costs, patients must also carry the burden of understanding and navigating their coverage. Four in 10 (42%) insured Americans say they can’t anticipate what they will pay for health care services, even if they are covered by their insurance plan. And one in five (18%) insured Americans spent two hours or more on paperwork, phone calls and other administrative tasks with their insurance company to get needed medicines in the past three months.
3. Insured Americans support policy reforms that make their coverage more affordable and predictable.
The Ipsos survey of over 5,000 insured Americans found that people favor solutions that improve insurance coverage. Fully one-third (33%) rank reducing the burden of deductibles by requiring insurance plans to cover more products and services before a deductible is met among their top two solutions, making it the top desired solution overall. Additionally, 90% of insured Americans want more predictability in their out-of-pocket costs so that they know how much they will pay for things like prescription drugs every month. And 58% of insured Americans would be willing to pay more in premiums if it meant better coverage.
PhRMA’s Patient Experience Survey (PES) is a research initiative to explore the challenges Americans face as they navigate the health care system. The poll was conducted among 5,103 American adults (age 18 or older), including 4,720 with insurance, from May 23 – June 1, 2022, using Ipsos’ probability-based KnowledgePanel®, and it is representative of the American adult population. The margin of sampling error is plus or minus 1.5 percentage points at the 95% confidence level, for results based on the entire sample of adults.