More than half of patients report health insurance denied coverage for critical medications

Commercially insured patients are being referred to work with external programs to obtain access to their medications, causing delays and negative impacts on their health and life.

A 2025 national poll from the PAN Foundation’s Center for Patient Research finds that in the past year, over half (54 percent) of insured adults with commercial insurance have been told by their health insurance plan that medications for their chronic or rare disease are no longer covered.

In addition, nearly half of commercially insured adults (48 percent) report that their health insurance plan referred them to work with an external company to obtain their medications, causing delays and negative impacts on their health and life.

About two in five adults (39 percent) opted to work with the external company they were referred to by their insurance plan. Among those patients, they reported the most common methods these external companies used to obtain the medication included:

• Importing the medication from an international pharmacy (44 percent)
• Securing the medication through a manufacturer’s patient assistance program (43 percent)
• Securing the medication through a charitable patient assistance foundation (40 percent)

Among those who opted to work with an external company, over one-third (39 percent) experienced a delay of one month or more from the time their medication was prescribed to when they began their treatment. In some cases, the delays were longer. Patients reported the following:

• Delays of one to less than two months: 13 percent
• Delays of two to less than four months: 15 percent
• Delays of four to less than six months: 3 percent
• Delays of six months and over: 7 percent

These delays adversely affected nearly all adults (92 percent), with the most common negative impacts being on their mental health (36 percent) and physical health (32 percent); making unplanned visits to their healthcare professional (30 percent); other challenges in their day-to-day lives (29 percent); and having to visit the emergency room or urgent care (25 percent).

Ultimately, among adults who worked with an external company to obtain their medications, half (49 percent) said their medication was eventually covered through their health insurance plan. The most common outcomes included:

• The medication was eventually covered by their health insurance plan (49 percent)
• The patient received support for the medication from a manufacturer’s patient assistance program (42 percent)
• The medication was imported from outside the U.S. (32 percent)
• The patient received financial assistance through a charitable foundation (32 percent)

“It is deeply troubling that a significant number of people with a chronic or rare condition report a loss of health insurance coverage for a medically necessary medication and are being referred to work with external companies to gain access to their treatment, often causing significant delays,” said Amy Niles, Chief Mission Officer at the PAN Foundation. “The findings of our research indicate how prevalent these practices are, often referred to as alternative funding programs. They can lead to increased out-of-pocket costs, adverse health effects, and significant and even life-threatening delays in care. That’s why we’re committed to educating policymakers and the public about the impact of these harmful policies and ensuring all patients can access the treatment they need.”

Resources

• How alternative funding programs prevent access to medications 
• Cómo los programas de financiación alternativa dificultan el acceso a sus medicamentos 
• PAN’s AFP explainer video 
• Provider story: A social worker helping patients navigate barriers to better hemophilia medications 
• 2023 national polling: Commercially insured patients on specialty medications report access issues 

Polling methodology

This survey was conducted online within the United States between July 15-17, 2025, among 2,080 adults (aged 18 and over) by The Harris Poll on behalf of the PAN Foundation via its Harris On Demand omnibus product.

Data were weighted where necessary by age, gender, race/ethnicity, region, education, marital status, household size, household income, [employment], and political party affiliation, to bring them in line with their actual proportions in the population.

Respondents for this survey were selected from among those who have agreed to participate in our surveys. The sampling precision of Harris online polls is measured by using a Bayesian credible interval. For this study, the sample data is accurate to within + 2.5 percentage points using a 95% confidence level. This credible interval will be wider among subsets of the surveyed population of interest.

All sample surveys and polls, whether or not they use probability sampling, are subject to other multiple sources of error which are most often not possible to quantify or estimate, including, but not limited to, coverage error, error associated with nonresponse, error associated with question wording and response options, and post-survey weighting and adjustments.

About the PAN Foundation

As a leading charitable foundation and healthcare advocacy organization, the PAN Foundation is dedicated to accelerating access to treatment for those who need it most and empowering patients on their healthcare journeys. We provide critical financial assistance for treatment costs, advocate for policy solutions that expand access to care, and deliver education on complex topics—all driven by our belief that everyone deserves access to affordable, equitable healthcare.

Since 2004, our financial assistance programs have helped more than 1.3 million people start or stay on life-changing treatment. In addition, we’ve achieved major policy victories that increase access to care, mobilized patient advocates to call for change, and educated people nationwide on critical healthcare-related topics. We’re committed to working towards a future where equitable health outcomes are a reality for all. To learn more, visit panfoundation.org.