Research from Johnson & Johnson and Evidera reveals that employer-based health insurance often fails to meet the needs of beneficiaries with chronic disease, as reported by participants. In a series of discussions, people dealing with chronic disease reported that health insurance is typically designed for healthy individuals and not for people like themselves. As a result, many spend significant mental and physical energy navigating their plans, while restrictions like prior authorization limit their access to needed medications and services.
The study included five 120-minute virtual focus group sessions with 27 U.S. residents recruited through Johnson & Johnson’s Patient Engagement Research Councils (PERCs) – programs comprised of U.S. residents living with various chronic diseases who share their knowledge and lived experiences to inform research and improve the understanding of patient needs. Patients representing various patient populations and demographics are recruited via patient advocacy groups and social media.
Interviewees expressed concerns about financial security, noting that while they expect high-quality coverage in exchange for higher premiums, many do not feel protected in the event of a serious health event. Some felt just “a single emergency or one hospitalization away from financial hardship and possible bankruptcy.” Health plan changes made by employers, such as switching carriers, were seen as disruptive and risky for people with chronic diseases.
Participants recommended that employers offer tailored insurance options for diverse health needs, enhance employer training on chronic disease, increase transparency around plan costs and changes, create opportunities for dialogue and act on beneficiary feedback to improve plan design.
This research was funded by Johnson & Johnson Innovative Medicine and conducted in collaboration with Evidera. For full details on the study design, methods and limitations, see: Doherty B, Neumann U, Falope Y, Genin R. Patient perspectives on employer-based health insurance: Experiences of employees with chronic diseases [abstract]. Journal of Managed Care & Specialty Pharmacy. 2025;31(10-d Suppl):S9. https://www.jmcp.org/doi/epdf/10.18553/jmcp.2025.31.10-d.s1. Poster presented at Academy of Managed Care Pharmacy (AMCP) Nexus 2025; October 27-30, 2025; National Harbor, MD.
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