1st Quarter 2008
Underinsured Means Uninsured: How Companies Are Improving Access
By Jane Erickson, Laura Grant Dong, and Elisabeth Heflin
Presidential candidates and the national media are quick to quote that the ranks of the uninsured have grown to at least 47 million Americans1, but few recognize that in addition to these uninsured, at least 16 million American adults are underinsured.2 The underinsured have insurance; however, their insurance is not sufficient to protect them from financial risk associated with their medical needs.
High deductibles, high cost shares, and limited coverage prompt many patients to avoid health care services and products. Many do not seek care when it is needed or are not compliant with treatment regimens due to the associated costs.
For many, being underinsured is equivalent to being uninsured. A Commonwealth Fund study demonstrated that the underinsured are almost as likely as the uninsured to go without needed health care. Over 35 percent of patients surveyed stated they changed their lives to pay their medical bills -- specifically, they made changes like selling a home, changing jobs, or going into debt to finance their medical care. 3
Increasingly, pharmaceutical and biotech companies recognize this problem and are developing solutions to address the needs of the underinsured. The models for delivering assistance include
- supporting one of the growing number of non-profit copayment assistance foundations, which provide financial support to patients with high cost sharing obligations;
- offering pharmacy cards that provide a discount or pay a copayment;
- creating product support programs with expenditure caps (once the patient has spent a certain amount out-of-pocket, the product is free for the remainder of the enrollment period);
- giving free product to patients who are temporarily without insurance coverage; and
- providing benefits counseling through patient support hotlines, which can review insurance options, petition for coverage, or counsel on coverage alternatives.
Each of these models has its benefits and drawbacks, and companies must pay particular attention to implementing programs that are compliant with federal anti-kickback statutes and that will not hurt Medicaid best price or average sales price.
As insurers have increased patient cost sharing, the industry has learned that it is vital to assist underinsured patients as well as the uninsured. Covance strives to assist companies in developing appropriate, forward-thinking solutions to maintain and broaden access to care.
 
Footnotes:
- 2006 US Census
- The Commonwealth Fund, "New Study: At Least 16 Million Adults Lack Adequate Health Insurance Coverage; Total Number of Uninsured and Underinsured Climbs to 61 Million." June 14, 2005; available at http://www.commonwealthfund.org/newsroom/newsroom_show.htm?doc_id=280619
- Cathy Schoen, M.S., Michelle M. Doty, Ph.D., Sara R. Collins, Ph.D., and Alyssa L. Holmgren, The Commonwealth Fund, "Insured But Not Protected: How Many Adults Are Underinsured?" Health Affairs Web Exclusive, W5-289-W5-302 ,June 14, 2005; available at http://content.healthaffairs.org/cgi/content/full/hlthaff.w5.289/DC1?ijkey=1hR6oh4Hhh2jc&keytype=ref&siteid=healthaff
Endnotes:
- Kaiser Commission on Medicaid and the Uninsured, "Underinsured in America: Is Health Coverage Adequate?" The Henry J. Kaiser Family Foundation . July 2002; available at http://www.kff.org/uninsured/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=14136 .
- Bob Moos, "Same Problem, New Solutions", Dallas Morning News, Inc . February 8 2007; available at http://www.dallasnews.com/sharedcontent/dws/news/nation/stories/DN-uninsured_08bus.ART.North.Edition1.2a54e7b.html
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