Learn about the real life impact of prior authorization from two cancer patients who have dealt with this issue firsthand.
Survey: Cancer Patients and Survivors Alter or Delay Care Due to Insurance Barriers
Issues Include Prescription Drug Coverage and Surprise Medical Bills
WASHINGTON, D.C.—December 5, 2019—Some recent and current cancer patients are making changes to their cancer treatment due to the coverage and cost of prescription drugs and surprise medical bills, according to new survey results from the American Cancer Society Cancer Action Network (ACS CAN).
The latest survey from Survivor Views, a national cohort of cancer patients and survivors who complete surveys on a range of public policy issues important to the cancer community, found nearly one-third of patients and survivors have experienced some insurance barrier to accessing prescription drugs necessary for their cancer care, more than half of lower-income respondents have had to act to reduce their prescription costs, and roughly one-quarter of all patients have encountered surprise medical bills—the large bills that result from a patient unknowingly receiving care or a service from an out-of-network provider.
The survey results come as Congress considers a series of end-of-the-year bills aimed at reducing patient out-of-pocket costs.
Patients surveyed report a variety of insurance barriers to accessing prescription drugs. The most common barriers were having to wait more than 24 hours for insurance approval (19%), being denied coverage for the doctor-prescribed drug (14%) or being required to try a less expensive prescription drug first (10%). Of those who experienced an insurance barrier, 79% reported experiencing at least one negative consequence including, having to spend time on the phone with their insurance provider (44%), paying for the prescription drug out-of-pocket (27%) and going without the prescription drug sometimes for a week or more (38%).
More than half (54%) of lower income patients have tried to reduce their out-of-pocket costs, including asking for a generic or biosimilar (29%), using a manufacturer’s coupon or assistance program (18%) or asking for a lower-cost drug to be prescribed (17%). While these methods may help reduce overall health care costs, other common methods may have serious negative impacts on patients’ health. For instance, low-income patients were more likely to delay treatment (17%), endure a side effect without treatment (17%), take an over-the-counter medication instead of a prescription drug (16%) or cut pills in half or skip doses of their prescription drugs (9%) than their higher-income counterparts.
Additionally, nearly a quarter of all survey respondents said they had experienced a surprise medical bill. The Federal Reserve reports four in ten Americans cannot afford an unexpected bill of $400 or more, yet the majority of the surprise bills respondents received were for over $500 and 21% totaled $3,000 or more.
Receiving these large, unexpected bills negatively affected patients’ behavior. Nearly 70% said they experienced anxiety about receiving another surprise bill and worried about how such bills might hinder their ability to pay for their care, 60% said they were less likely to follow-up with a doctor-recommended specialist who may be out-of-network, and 42% said they were less likely to call an ambulance when experiencing a serious cancer-related health issue. Nearly one-third also reported that they would be less likely to get a certain treatment because of cost concerns and would be less likely to go to the emergency room for a serious cancer-related health problem.
“Cancer patients and survivors need ready access to the right prescription drugs and care to treat their disease and side-effects at affordable prices. These results demonstrate the growing obstacles—both administrative and financial—that stand in the way of patients’ ability to get necessary care,” said Lisa Lacasse, president of ACS CAN. “On behalf of all cancer patients, we urge lawmakers to work together and swiftly pass meaningful bipartisan legislation to lower costs and increase access to prescription drugs and eliminate surprise billing. Patients cannot wait.”
A detailed summary of the key findings can be found here.