Lowering Cost
Every American deserves access to affordable, comprehensive, high-quality coverage and care. But health prices continue to escalate year after year, making coverage and care less accessible for everyone. Health insurance providers are committed to developing solutions to provide all Americans with more health care choices and better quality at lower costs.
Ensuring Affordability
Every American deserves access to affordable, comprehensive, high-quality coverage and care.
But health care prices for medical care, prescription drugs, and other health care services and devices continue to escalate year after year. We all have a responsibility to work together to make coverage and care more affordable and accessible for everyone.
82.4 cents of every premium dollar go to prescription drugs and medical services – up from 81.6 cents from an analysis released in 2020.
By improving competition in our health care system, we can improve affordability and access for everyone.
- By the end of 2020, nearly half of American doctors were employed by hospitals/health systems (49.3%).
- 18,600 doctors left independent practice and became employees of hospitals in 2019 and 2020.
- Hospitals acquired 3,200 physician practices during 2019 and 2020, for an 8% increase in hospital-owned practices.
- 22.2 cents of every dollar spent on health insurance premiums goes to pay for prescription drugs – more than any other individual category.
- While generic drugs represent 90% of prescriptions filled, they account for only 18% of prescription drug spending.
- Together, health insurance providers and PBMs will save health plan sponsors and consumers more than $1 trillion between 2020 and 2029.
Factors increasing costs include:
- Certain providers, hospitals, and health systems who markup prices and impose unreasonable contract terms
- Mandates, including mandates to cover specific prescription drugs, therapies, and treatments
- Anti-competitive practices by pharmaceutical companies aimed at improving revenue
- Restrictions on prior authorization and other important medical management tools that help ensure evidence-based, effective, high-value care
Factors decreasing costs include:
- High-quality provider networks
- Medically necessary, evidence-based health services
- Drug formularies
- Value-based care models
- Prior authorization and other medical management tools