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

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.