State Policies to Improve Access to Primary Care and Prescription Drugs in Private Health Insurance Plans

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Private health insurance provides 170 million Americans with access to affordable primary care and prescription drugs. Yet 34 percent of those with private health insurance report delaying or foregoing primary care because of cost. Twenty percent of prescriptions go unfilled and 14 percent of patients take less than the prescribed dose because of high cost-sharing.

Some states have attempted to improve upon the ACA standards by adopting laws and regulations designed to improve access to basic primary care services and prescription drugs. For this project, researchers from Georgetown University’s Center on Health Insurance Reforms (CHIR) will build a database of federal and state policies that directly affect consumers' out-of-pocket costs for primary care services and pharmacy benefits in private health insurance plans. This study will use the database to identify states with innovative and translatable approaches to improving access to services and select up to 10 states for more in-depth study. The researchers will conduct structured interviews with state insurance regulators, insurers, providers and patient advocates in each of these states. Interviews will be designed to ascertain how state and federal laws are working in practice to address potential barriers to care, as well as areas in which improvement is still needed.

Evidence

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Sandy Ahn and Sabrina Corlette from the Center on Health Insurance Reforms at Georgetown University released a paper analyzing the findings from a 50-state review of policies that lower consumers’ cost-sharing for expensive prescription drugs. The research was supplemented by in-depth interviews with officials and stakeholders in four states with such policies.

Sandy Ahn and Sabrina Corlette from the Center on Health Insurance Reforms at Georgetown University released a paper analyzing the findings of state laws that lower consumers’ financial barriers to key health care services. The research included a survey of laws and policies in all 50 states and D.C., and in-depth interviews of stakeholders in four states with such policies.