IPM Take
Precision medicine is built around a compelling promise: the right intervention for the right patient at the right time.
The KFF data show how easily that promise can break after the clinical decision has already been made.
Among insured adults aged 18 to 64 with three or more active health conditions, 49% reported that their insurer had denied coverage or delayed access to a service, treatment or medication requested by them or their clinician during the previous two years. The figure was 45% among adults treated for cardiovascular disease, 43% among those treated for cancer and 47% among those with a mental health condition.
This was not simply an uninsured problem. Among people with three or more conditions, reported delays or denials were similar across employer-sponsored insurance, Medicaid and non-group coverage, at 49%, 50% and 54%, respectively. The survey cannot determine whether every denial was inappropriate, and the category includes more than prior authorization, such as formulary restrictions or services excluded from coverage. But from the patient’s perspective, the practical result can be the same: a prescribed pathway becomes harder or slower to reach.
That should matter to anyone discussing personalised medicine. Access is not the final administrative step after innovation. Access is part of whether innovation works.
Executive Summary
The KFF Survey of Health Access and Caregiving was conducted from 4 to 26 May 2026 among a nationally representative sample of 25,873 US adults, including 16,677 who said they had received treatment for at least one health condition during the previous year. The survey examined people treated for cardiovascular disease, cancer, diabetes, lung disease and mental health conditions, as well as adults managing three or more conditions from a broader list of 18.
Among adults aged 18 to 64 with three or more conditions, 52% reported at least one barrier to obtaining needed care during the previous year. Thirty-six percent skipped or delayed care because of cost, 25% could not find an available appointment and 28% delayed care for another reason. Among those with cardiovascular disease, 49% reported at least one access barrier.
These barriers were not benign. Twenty-seven percent of adults with multiple conditions said their health became worse after they skipped or delayed care. The proportion was 24% among those with cardiovascular disease, 18% among adults treated for cancer and 32% among those with mental health conditions. These outcomes are self-reported and cannot establish that the delay alone caused the deterioration, but they show that access problems are experienced as clinically consequential, not merely inconvenient.
Medication affordability created another barrier. One-quarter of adults aged 18 to 64 with three or more conditions said they had cut pills, skipped doses or decided not to fill a prescription because of cost during the previous year. Rates were 22% for cardiovascular disease, 22% for diabetes, 19% for cancer and 25% for mental health conditions.
The burden became markedly worse without insurance. Among uninsured adults aged 18 to 64 with multiple conditions, 72% reported difficulty paying medical bills, 68% skipped or delayed care because of cost, 51% did not take medicines as prescribed because they could not afford them and 43% said their health worsened after delaying care.
Why it matters
- HTA bodies: Demonstrating clinical value is only one part of delivering real-world value. If patients cannot navigate coverage, afford associated services or access providers, effectiveness in routine practice may diverge sharply from efficacy demonstrated in trials. Implementation and access requirements should therefore be considered alongside the technology itself.
- Payers: Utilisation management may be intended to control inappropriate spending, but administrative friction has consequences when it delays care for people with multiple serious conditions. Payers need better evidence on which restrictions improve value and which simply shift costs downstream through worsening disease, emergency care or treatment interruption.
- Industry / innovation partners: Launch strategy cannot stop at regulatory approval and reimbursement. Complex therapies increasingly depend on diagnostics, specialist referrals, monitoring and continuing treatment. Companies developing personalised medicines will need to understand the entire access pathway, including where patients are lost after a prescription or treatment decision is made.
Modern medicine is becoming extraordinarily good at identifying who might benefit from a particular treatment.
Genomic testing can divide cancers into molecular subtypes. Biomarkers can identify patients most likely to respond to targeted medicines. Cardiometabolic treatment is increasingly stratified by cardiovascular risk, kidney disease, obesity phenotype and other comorbidities.
But the KFF findings expose a less sophisticated reality.
For many patients, the decisive question is not whether medicine can identify the right treatment. It is whether the health system allows them to reach it.
Among insured adults under 65 managing three or more health conditions, 41% said an insurer had denied coverage for requested care during the previous two years and 37% reported a delay. Because some people experienced both, the combined figure was 49%.
The finding deserves careful interpretation.
KFF asked patients about their experiences. It did not adjudicate whether individual coverage decisions were clinically justified, nor did it classify every reported problem as prior authorization. Delays and denials can arise from formulary rules, benefit exclusions, prior authorization or other coverage requirements. Self-reported experiences may also differ from administrative claims records. KFF itself has previously noted that patient-reported denial rates can exceed those captured in administrative data.
But focusing only on whether every denial was technically appropriate risks missing the access problem.
A patient with one straightforward condition may be able to absorb an administrative delay. A patient simultaneously managing diabetes, cardiovascular disease, kidney disease and depression may already be coordinating specialists, prescriptions, laboratory monitoring and appointments. Each additional authorization or affordability barrier enters a much more fragile care pathway.
Coverage protects patients, but coverage alone is not enough
The difference between insured and uninsured adults remains enormous.
Uninsured adults with multiple conditions were approximately twice as likely as insured counterparts to delay care because of cost, 68% versus 35%, and to underuse prescribed medicines because of cost, 51% versus 24%. They were also much more likely to report difficulty paying medical bills.
That reinforces the value of insurance rather than diminishing it. Broader evidence also shows that gaining coverage improves healthcare access, affordability and financial security.
But the new survey highlights the next policy problem: coverage is necessary, but it is not synonymous with access.
Even among adults with insurance, disease burden was strongly associated with difficulty navigating the system. For insured people under 65 without an active condition, 19% reported an insurance delay or denial. Among those with three or more conditions, the figure rose to 49%.
The same pattern persists after age 65. Despite widespread Medicare coverage, 25% of older adults with three or more conditions said an insurer had denied or delayed a requested treatment, service or medicine during the previous two years. One in ten reported altering or not filling prescriptions because of cost.
Access gets harder precisely when care gets more complex
For personalised medicine, this may be the most important finding.
New therapies rarely arrive alone. A targeted cancer drug may require molecular testing. A precision cardiovascular therapy may depend on imaging or genetic confirmation. Advanced metabolic treatment can require specialist initiation and repeated monitoring.
Every added component creates another point at which coverage, affordability, provider availability or administration can interrupt care.
Cancer makes the problem particularly visible. Among insured adults aged 18 to 64 receiving cancer treatment or medication, 43% reported an insurance delay or denial. Among all adults in that age group treated for cancer, 18% said their health had worsened after care was skipped or delayed.
That does not mean insurers caused those outcomes. The survey cannot establish such causality.
It does mean that a healthcare system capable of designing increasingly sophisticated treatment pathways must pay equal attention to whether patients can move through them.
The political debate around healthcare innovation often begins with discovery and ends with approval.
Patients live in the space after approval.
They encounter the copayment, the unavailable appointment, the formulary decision, the authorization request, the rejected claim and the prescription that is technically available but financially unreachable.
For precision medicine, there is little value in identifying the right treatment for the right patient if the system cannot deliver it at the right time.
Access is not what happens after personalised medicine. It is part of personalised medicine itself.
