Improving access & affordability

Why affordability matters

Medical advances don’t mean much if the people who need them most can’t afford them. But that’s the reality for millions of people today—even those with employer-sponsored health insurance or Medicare. Rising premiums, deductibles, co-pays, and coinsurance are leaving more Americans than ever underinsured and unable to afford treatment.

55% percent of American adults worry a great deal about whether healthcare will be available and affordable.

Recent surveys show that due to high out-of-pocket costs, a rising number of Americans:

  • Don’t go to the doctor when they’re sick
  • Skip routine preventive care
  • Take less of their medication or don’t fill their prescriptions at all
  • Forgo recommended medical tests, treatments, and surgeries

Source: Kaiser Family Foundation, 2019

According to the Kaiser Family Foundation, 50% of U.S. adults say they or a family member delayed or skipped health or dental care, or relied on an alternative treatment, in the past year due to cost.

PAN and other charitable patient financial assistance programs provide a critical safety net for many of the most vulnerable people with serious health conditions. But it’s not enough.

Unless we change the system, the situation is likely to only get worse. A recent Kaiser Family Foundation report predicts that by 2030, people with Medicare coverage and incomes below $10,000 will spend more on out-of-pocket healthcare costs than the average Social Security income.

Our Recommendations

Put patients first to improve healthcare access and affordability

The problem of healthcare access and affordability is complex. But solutions are possible. Below are the key ways we believe we can put patients first—and make sure that high costs never stand between anyone and the care they need.

  • 1

    Recognize that out-of-pocket costs should not prevent people with life-threatening, chronic, and rare diseases from getting the critical treatment they need.

  • 2

    Expand the critical safety net that today’s charitable patient financial assistance programs provide.

  • 3

    Cap the costs of prescription medications through monthly or yearly limits.

We purchased the best Medicare Supplemental Insurance plan, but when I was told the co-pay on one medication would be $3,000 per month, I was shocked.

Ira, a grant recipient living with cancer
  • 4

    Spread out-of-pocket medication costs more evenly throughout the year.

  • 5

    Ensure that all health conditions have at least one highly effective innovator drug on a fixed co-payment tier.

I was prescribed a new treatment in 2012, but couldn’t afford it. I considered not starting the treatment, until my pharmacist mentioned PAN.

MaryAnn, living with Crohn’s disease
  • 6

    Modernize the Medicare Part D Low-Income Subsidy (LIS) program to increase enrollment and provide continuity for individuals from one year to the next.

  • 7

    Update the Medicare Part D structure to reflect the current prescription drug landscape and improve access.

  • 8

    Limit high front-end deductibles that can create barriers to treatment for people who need it most.

  • 9

    Encourage value-based insurance designs that improve access for those living with life-threatening, chronic, and rare diseases.

  • 10

    Take into account the total out-of-pocket cost of care when developing policy solutions to decrease the financial burden of care for Americans.

  • 11

    Prohibit programs like co-pay accumulators that increase out-of-pocket costs for those with serious health conditions.