National polling: Commercially insured patients on specialty medications report access issues

A recent national poll from the PAN Foundation finds that many commercially insured patients taking specialty medications report facing medication access issues through their employer-sponsored health plans.  

Key findings include:  

• 1 in 4 respondents (25 percent) covered by commercial insurance say their plan has told them that the specialty medication they need access to is a “non-essential health benefit.” 
• 1 in 3 respondents (29 percent) covered by commercial insurance say they have been referred to an external company by their plan to help them find financial assistance for their specialty medication. 
• 1 in 3 respondents (28 percent) covered by commercial insurance have been told the financial aid they receive for their specialty medication will not count toward their deductible or out-of-pocket maximum.

“We are alarmed by the prevalence of patients reporting that their health insurance plans have instituted barriers to accessing their specialty medications,” said Amy Niles, Chief Advocacy and Engagement Officer at the PAN Foundation. “Access to specialty medications prescribed by healthcare providers should be deemed an essential health benefit, and their costs should be covered by health plans. The findings suggest that many employer-sponsored health plans may include copay accumulator policies and alternative funding programs in their strategy. We’re committed to educating policymakers and the public about the impact of these harmful policies and ensure all patients can access the treatment they need.” 
 
Copay accumulators, maximizers, and alternative funding programs lead to greater out-of-pocket costs for individuals with serious illnesses and should be banned. Congress and the Centers for Medicare and Medicaid Services should prohibit these harmful programs, require health insurance plans to apply financial assistance received by or on behalf of a patient toward their out-of-pocket maximum, and require health plans to deem all prescription medications, including specialty medications, as essential.

Polling methodology: This poll was conducted by Morning Consult on behalf of the PAN Foundation between October 28-29, 2023, among a sample of 2,200 adults. The interviews were conducted online and the data were weighted to approximate a target sample of adults based on age, gender, race, educational attainment, region, gender by age, and race by educational attainment. Results from the full survey have a margin of error of plus or minus 2 percentage points. 

About the PAN Foundation   

The PAN Foundation is an independent, national 501 (c)(3) organization dedicated to helping federally and commercially insured people living with life-threatening, chronic, and rare diseases with the out-of-pocket costs for their prescribed medications.   

Since 2004, we have provided more than 1.1 million underinsured patients with $4 billion in financial assistance. Partnering with generous donors, healthcare providers and pharmacies, we provide the underinsured population access to the healthcare treatments they need to best manage their conditions and focus on improving their quality of life. Learn more at panfoundation.org.