Three things to know from the latest Patient Experience Survey

Most insured Americans believe insurance should provide affordable access to health care (93%), but only a third (34%) say it does, according to the fourth installment of the Patient Experience Survey (PES). The survey — based on interviews with 5,000 Americans — explores this disconnect, detailing the challenges insured Americans face affording care and how practices by health insurers and middlemen put patient lifelines to access at risk.

Here are three things you should know.

1. Out-of-pocket health care costs, such as copays, deductibles and coinsurance, are a top health care concern (32% selected as a top issue).

In fact, more insured Americans say they are concerned about their ability to afford their health care out-of-pocket costs (57%) than about affording expenses like the costs of healthy food (45%) or transportation (40%). And one in five (19%) insured Americans say their health care out-of-pocket costs would be more than they could afford if they had a major unexpected medical event or were newly diagnosed with a chronic illness.

2. Health insurer and pharmacy benefit manager (PBM) practices put patient lifelines to access at risk.

Nearly three in 10 (29%) insured Americans taking prescription medicines report being subject to utilization management practices, such as prior authorization and step therapy, which can restrict or delay patients’ access to medicines. Drilling down on specific practices, 22% report being subject to prior authorization in the past year and 20% report facing a formulary exclusion. These practices are particularly concerning for patients with a chronic disease, who are disproportionately more likely (36%) to face these access restrictions.

3. Insured Americans call for lower out-of-pocket health care costs, increased transparency and better predictability.

Overwhelming majorities support patient-centered policies, such as ensuring more predictability in health care costs so people know how much they will pay (90%) and requiring health insurers to pass on any rebates or discounts they receive on medicines so patients pay less at the pharmacy counter (89%).

84% of insured Americans agree Congress should rein in tactics by insurers and their PBMs that drive up health care costs and make it harder for patients to get the medicines they need.

Read the full Patient Experience Survey report here and learn more about patient-centered solutions at PhRMA.org/Middlemen.

Find a detailed summary of findings from Ipsos here. 

PhRMA’s Patient Experience Survey is a research initiative to explore the challenges Americans face as they navigate the health care system. The poll was conducted among 5,152 American adults (age 18 or older), including 4,823 with insurance, from April 4 – 17, 2023, 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.