In their own words: Financial barriers exacerbate access challenges for insured Americans

A survey of more than 5,000 Americans conducted with Ipsos found that 30% of insured Americans say they face a financial barrier to care, such as unaffordable out-of-pocket costs or a lack of savings to pay for emergency or unforeseen expenses.

The data, from the third installment of the Patient Experience Survey, showcases the insurer- and pharmacy benefit manager (PBM)-imposed barriers and cost sharing practices that stand between these patients and their medicines.  

Key findings, along with examples from patients in their own words, from the latest PES report include: 

1. Certain communities are more likely to face financial barriers to care. For example, compared to 30% of all insured Americans, 37% of women with insurance face a financial barrier to care.  

2. Patients are particularly struggling with out-of-pocket costs. Fifteen percent of insured Americans say their out-of-pocket costs are more than they could afford if they had a major medical event or were diagnosed with a chronic illness. This is especially the case for women (19%), LGBTQ+ Americans (19%), Hispanic Americans (21%) and Black Americans (22%). 

3. Americans with high deductibles face greater financial barriers than those without them. One in five (20%) Americans in high deductible health plans (HDHPs) say they have out-of-pocket costs that are more than they can afford, and they wouldn’t be able to afford health care if they became seriously ill, compared with 14% for insured Americans without high deductibles. This finding is supported by a new analysis which found that in 2021, commercially insured patients with deductibles or coinsurance spent six times more out of pocket, on average, for their brand and generic medicines than those with only copays.

To alleviate the financial challenges patients face, insured Americans favor policy solutions that require insurers and middlemen like PBMs to pass on the savings and improve their health insurance coverage. Such solutions will lower out-of-pocket costs, increase transparency and provide more predictability for patients at the pharmacy counter. To learn more about these challenges and desired solutions to address Americans’ true concerns, visit PhRMA.org/Middlemen. 

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. The latest PES also features qualitative data from hours of in-depth interviews.