HCPs and patients agree: Insurance, PBM practices need to change

Recent survey results show that while HCPs and patients agree that the United States is a great place to live for healthcare, the implementation is lacking.

PhRMA and Ipsos released its Patient Practitioner Research report, which is based on a survey fielded among the two groups in January of this year. The study explores the challenges health care practitioners (both doctors and nurses) and Americans over the age of 18 face with the health care system.

The survey evaluated the following four key areas: current state of healthcare, patient-practitioner relationships, insurance and reform. PhRMA noted on its website that “health care practitioners (HCPs) and patients are concerned about complexities in the system that negatively impact patients’ access to quality care.”

That complexity among those who believe that healthcare has gotten worse in the past two to three years base it on increasing “red-tape.”

Insurance concerns

Further, to complexity in insurance, the results found that 91% of HCPs and 77% of patients “agree strongly or somewhat that health insurers intentionally make coverage benefits complicated so they can increase their bottom line.”

And six out of 10 of insured patients—or 57%--said they strongly agreed or agreed that they won’t be able to get the medicines they need because of insurance company or PBM restrictions.

Almost half of respondents have experienced prior authorization. Of those, 58% comprised those with chronic disease (58%) patients and 65% of caregivers and 60% of middle-aged Americans ages 45-64 and 57% of seniors.

Reform

HCPs and patients point to insurance companies and PBM practices as the reason for high healthcare costs of in the United States, and they want the government to step in. This is followed by a series of checks supported by the two groups that should be implemented against insurers and PBMs. These include no usage of copay maximizers and a maximum limit on out-of-pocket costs insured persons pay per year for prescription medicines.

The next coming years should prove eventful in regard to many of these issues. Copay maximizer limits are playing out at the state level, and PBM reform has bipartisan support in Congress. Stay updated at our upcoming conferences, as well as with our enewsletter.

DEPOSITPHOTOS@EdZbarzhyvetsky