Background: The COVID-19 pandemic amplified traditional access barriers for patients. However, responses to the pandemic have also seen attempts to avoid negative health consequences with improved access. Appropriate and well-understood access is a threshold condition for timely diagnosis and adherence but must be supported by both regulatory and reimbursement decisions. Americans often delay medical care due to inconvenience and out-of-pocket expense, particularly as many are responsible for growing out-of-pocket medical expenses under high-deductible employer plans. Non-adherence has been estimated to cost billions annually in the US alone. Patients who received health literacy interventions have shown a higher rate of treatment adherence than did those who did not, suggesting that millions of US adults with low health literacy could be assisted to better adherence with improved health literacy.

Objective: We review the trends in access related to COVID-19 and contextualize, provisionally, how these changes may continue to improve access after the pandemic.

Developments: Government and private insurers responded by expanding access with lower out-of-pocket costs and greater leveraging of technologies for more convenient care. These technologies, like telemedicine and remote monitoring in trials, can enhance the evidence available for regulatory and reimbursement policy decisions, including data on relevant subpopulations. Access to COVID-19 related care was enhanced with lower OOPs, and chronic conditions advantageously reclassified as preventative medicine. Coverage expanded for telemedicine and mail order and home delivery. Physicians conducting video chats increased by 159% and telemedicine by 106% in March compared to a year ago.

Conclusion: Access has been improved and there has been greater utilization of digital technologies that can enhance both outcomes and evidence. However, the level of health literacy with respect to these changes remains an open question.