Pharmaceutical Commerce features PAN commentary on insurance barriers delaying patient care

Pharmaceutical Commerce recently featured commentary by Amy Niles, PAN’s chief mission officer, about insurance-related barriers to healthcare and their impact on patients. The article highlights key takeaways from the 2025 State of Patient Access Report and scorecard, published by the PAN Foundation’s Center for Patient Research.

For the second year in a row, patients living with a chronic condition rated their ability to access treatment through health plans a “D” – the lowest grade for patients. Almost half (48 percent) of insured patients who take prescription drugs report facing some form of insurance-related barrier to accessing their prescriptions. These barriers include high deductibles, increased cost-sharing, formulary restrictions, step therapy, and prior authorization practices.

In the article, Niles also covers several pieces of legislation that can help address the barriers patients are facing, including:

• The Safe Step Act, which ensures that employer health plans, including their contracted PBMs, offer an expedient and medically reasonable step therapy exceptions process
• The Improving Seniors’ Timely Access to Care Act, which would establish an electronic prior authorization process for MA plans, and increase transparency around prior authorization requirements
• The HELP Copays Act, which would require that all payments made by or on behalf of a patient, including copay assistance, to count toward their deductible, and close loopholes that allow employer health plans to classify certain medications as “non-essential”
• Federal legislation to ban alternative funding programs (AFPs). With AFPs, health insurance plans may deny coverage for specialty medications and then require patients to choose between enrolling in an AFP or paying in full for the medication. This delays access to medications and increases out-of-pocket costs for patients with rare and chronic health conditions.