Insured Americans can't predict drug costs: survey
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More than half of insured Americans say they can't predict how much their covered prescription drugs will cost, according to an annual survey by the pharmaceutical industry trade group PhRMA.
Why it matters: The results, shared first with Axios, come as the drug industry is pressing for more transparency regulations on pharmacy benefit managers and insurers in the lame-duck period following the election.
- The survey points to high deductibles making it difficult for more Americans to cover out-of-pocket medical expenses.
State of play: 51% of Americans with insurance say they can't predict how much their covered prescription medications will cost.
- 38% of insured adults taking prescription medications reported rising out-of-pocket costs for their medications in the last year.
- 28% of people with insurance said health coverage provides everyone with access to care when it's needed. That's down from 34% of insured adults surveyed last year.
- PhRMA partnered with Ipsos on the survey, which queried 2,600 people, 1,676 of whom took prescription medicine.
What they're saying: Many Americans "don't believe that the system is working for them. Their costs are going up, they're getting less affordable coverage, and some complain about more bureaucracy," said Mark Keida, public affairs vice president at PhRMA.
The data echoes other research showing that insured Americans have difficulty navigating their coverage.
Zoom out: More than 60% of adults with insurance said they'd support health insurers and pharmacy benefit managers to pass any rebates and discounts from drugmakers along to patients. Congress is currently considering bills that would require this.
- Other research has also shown wide public support for allowing the federal government to negotiate drug prices in Medicare as a way to bring down drug costs.
- PhRMA maintains that this policy, enacted in 2022, stifles innovation and did not ask about it in the survey.
The other side: "Employers and other plan sponsors always make the final decisions when it comes to pharmacy benefits, and PBMs offer and encourage their employer clients to consider any number of options to facilitate benefit designs that result in lower out-of-pocket costs while maintaining affordable premiums," Greg Lopes, vice president of public affairs and communications at PCMA, told Axios.
- He noted that average out-of-pocket costs for retail prescriptions fell from $10.39 in 2018 to $9.78 in 2023 across all payers, according to IQVIA.
- Health plans also work to shield consumers from high drug prices by negotiating savings and promoting low-cost generics, said Chris Bond, spokesperson for insurance trade group AHIP.
Of note: 52% of respondents to the survey said that their out-of-pocket costs were actually affordable.
- 33% said their costs were expensive. Among people with commercial insurance, that figure jumped to 38%. Overall, 13% of adults reported costs as unaffordable.
