Consumers Emphasize Insurer Role in High Healthcare Spending

Most Americans reported that health insurers are not successfully deflecting high healthcare spending and many survey respondents sought more transparency and out-of-pocket healthcare spending support around prescription drug spending, according to a survey from PhRMA and Ipsos.

PhRMA surveyed over 2,500 adults through a third party’s online platform. The survey period lasted from February 11 through February 16, 2022.

The results revealed widespread dissatisfaction with healthcare costs, health insurance practices, and lawmakers’ strategies around lowering healthcare spending. 

More than seven out of ten respondents (72 percent) agreed that health insurance companies are not fulfilling their role of granting access to care and protecting consumers from high healthcare spending. Seven out of ten respondents agreed that health insurance and out-of-pocket healthcare spending costs are not reasonable, while 21 percent had no opinion on the matter.

“Many frustrations with health care hinge on inadequate health insurance coverage, the confusion with navigating health insurance barriers to access, and the unexpected expenses and coverage issues patients experience,” the press release explained. 

“Americans want to see solutions around out-of-pocket costs, along with more transparency and predictability in cost from health care institutions.”

More than four out of ten respondents (43 percent) stated that either the respondent or a family member faced one or more insurance barriers that hindered their access to prescription drugs, including prior authorizations and lack of coverage for necessary medications.

According to the fully annotated questionnaire, a fifth of respondents had to wait for prior authorizations to receive their prescriptions. Another fifth stated that their prescriptions were not covered under their health plans.

Americans wanted more transparency around these barriers. More than eight out of ten respondents (83 percent) wanted to see health insurers publicly post information about their rate of claims denials for populations with specific diseases, and 77 percent wanted to make public insurers’ rates of denials for provider-recommended care.

Additionally, most of the survey participants (77 percent) wanted health insurance companies to inform members when a drug is less expensive to pay for a drug in cash than it would be to pay through the health insurance company.

Almost four out of ten participants reported anxieties around their ability to pay for healthcare, echoing past surveys that uncovered similar trends. These concerns can lead to delayed or foregone care, which can have downstream health impacts.

Health insurance costs seem to be more personal than prescription drug costs. One-third of Americans indicated that measures that cap consumers’ health insurance costs have a more profound personal impact. 

Additionally, 17 percent of respondents stated that incentivizing health plans to drive down prescription drug spending for ill members would make a personal impact.

In contrast, only 15 percent stated that increasing pharmaceutical companies’ transparency about prescription drug costs and cost assistance would have a positive personal impact. Seven percent said that counting pharmaceutical manufacturers’ cost-sharing assistance toward health insurance costs like deductibles would have a personal effect.

Americans wanted policymakers to focus on the costs that they perceived as making the most significant impact on personal healthcare spending. 

When given the option between reducing insurance-related costs such as deductibles and premiums and reducing drug prices, slightly more than seven out of ten participants (71 percent) stated that they wanted Congress to focus on reducing insurance-related costs.

In addition to cost-related concerns, the survey also highlighted patient education gaps. Over four in ten respondents (43 percent) stated that they had trouble navigating their health insurance.

However, health insurance companies were not the only source of anxiety for participants. Respondents also supported receiving greater transparency from hospitals and clinics about prescription cost mark-ups (85 percent). Nearly the same share of respondents agreed that pharmaceutical companies should make prescription costs more accessible.

In a fragment of good news, the survey revealed that most Americans could afford prescription refills. Over eight in ten Americans agreed or somewhat agreed that they could afford their prescription refills (82 percent). Eleven percent of respondents had skipped filling a prescription in the past year. 

Thirty-two nations’ combined drug spending failed to exceed drug spending in the US in 2020. Experts say these high spending levels by a single country are primarily driven by prescription drug pricing.

Drug pricing has been a critical legislative focus and featured in President Joe Biden’s first State of the Union address.