New Data Underscores that Access Barriers for Patients Are High ... and Getting Higher

It’s not often that I get excited about more email, but lawyer Bill Sarraille has a new newsletter that is worth the click. I link to Bill’s work on LinkedIn a lot -- I’m an especially big fan of his 340B takes -- and it’s good to see him get into newsletters, which might be a better match for his style. Give him a subscribe.

This new PhRMA/Ipsos poll is a treasure trove of data about how patient experience the health system. Not for nothing, the effort is called the “Patient Experience Survey.” It’s well with reading in its entirety. (`Axios has coverage, too, though what caught their eye is different from my take.)

The overarching point is that health insurance is no longer working for most Americans, especially when it comes to prescription drugs. The most notable bit for me was the section on access challenges: 41% of respondents said they’d had trouble accessing meds (for themselves or their family) in the past 12 months. Almost one in four dealt with a prior auth. More than 20% dealt with a formulary exclusion. 

This confirms what pretty much everyone feels about health insurance: a lot of time and effort has been put into making it as hard as possible to get the medicines that doctors prescribe. That’s probably why only one of every four Americans believes that “Insurance currently provides everyone with affordable access to health care, when it’s needed.”

The big question with polling is always: Do the results reflect reality? A lot of polling creates artifacts based on poorly worded questions or a lack of understanding. 

But here, the results line up with what’s happening in the environment.

Case in point: there is a new Cencora analysis of Medicare Part D plans for 2025. For months, folks have been warning that there will be more access challenges in Part D, and -- sure enough -- the Cencora analysts found that formulary exclusions are up an average of 7%. 

A whopping 46% of all branded meds will require prior authorization. That means that if you’re a senior and you walk out of a doctor’s office with a script, you have a 50/50 chance of being able to get that script filled without your doctor being forced to jump through hoops. 

Obviously, there are financial implications to all of this, but there are health consequences, too. Access barriers -- and concerns with raising out-of-pocket costs -- translate into worse adherence and worse outcomes. Making meds less accessible doesn’t help the public health. 

That’s part of what makes the latest No Patient Left Behind campaign so effective (if you haven’t seen it, they’re doing ads questioning cost-sharing for everything from cancer treatment to insulin to asthma. 

There’s no question that adding burdens to patients makes health worse. And yet … 

You all know that I struggle with writing about politics. Process stories are rarely very useful, and pieces about campaign promises tend to be divorced from actual policy priorities.

THAT SAID: I’d rather see journalists spend their time trying to unpeel the onions on what candidates would do if elected, rather than get suckered into the distraction of the latest viral moment or empty-calorie horserace coverage. 

So just because I don’t find it edifying right now (and you probably don’t either) doesn’t mean it’s not a noble undertaking. Anyway: if you’re into that sort of thing, here’s STAT, NYT, and NPR with their takes on where the candidates stand on drug pricing. 

Elsewhere: 

• Here’s a Washington Post interview with JC Scott, the head of the PBM lobby. I found it vaguely unsatisfying, but your mileage may vary. It’s a great summary of the existing talking points, and while the Post hits on a lot of the areas of controversies, the converstaion never quite goes deep. 

• Frank David and Stacie Dusetzina have a worthwhile JAMA Oncology piece on how the IRA will impact oncology meds, cautioning that there are elements of the law that are likely to both help and hurt the case for cancer drug development. But what I really like is the suggestion that oncology could be a great testing ground for some fine-tuned incentives to boost the kind of development likely to lead to the most important outcomes. 

• This is a good look at the convoluted structure of the 340B program from Doug Holtz-Eakin, the President of the American Action Forum. He breaks down one of the underlying problems of 340B: it’s not that the program’s aims are remotely bad. It’s just that the way that the law works encourages opacity and abuse. Unfortunately, this is not a simple argument to make, but once someone sees the structural flaws in the system, it’s really hard to unsee. 

• CMS is ready to work with the transition team of the president-elect on the next round of price controls, per Politico. This is not actually a meaningful story, but it is a reminder that the list of the next 15 meds up for forced “negotiations” is going to hit on Feb. 1 … almost immediately after the new president enters office. 

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