Fewer drugs are being covered by health insurance plans, and the ones that are covered face more restrictions, according to an analysis published March 16 by GoodRx.
GoodRx, an online platform that provides users with coupons for price cuts on prescription drugs, analyzed 3,594 health insurance plans from 2010 to 2019 and found three main trends:
- Insurance plans are covering fewer drugs
- Insurance on covered drugs is becoming more restrictive
- Patient share of the costs for copays, coinsurance and deductibles is rising
Researchers found that, on average, the share of drugs covered on Medicare plans dropped by 17 percent from 2010 to 2019. In 2010, an average plan covered 73 percent of all prescription drugs. In 2019, 56 percent of prescription drugs were covered by an average Medicare plan.
It's likely that commercial insurance plans have seen even steeper decreases in coverage since they have fewer mandatory coverage requirements than Medicare.
Pharmacy benefit managers are dropping more drugs from their formularies. In 2015, CVS Caremark and Express Scripts, two of the country's largest PBMs, dropped 48 drugs. In 2019, they dropped 91.
In a GoodRx survey of more than 1,000 patients, 15 percent said that one or more of their prescriptions had been dropped from coverage in the last year, and 26 percent said they had one or more prescriptions that aren't covered by their insurance.
PBMs often say they drop drugs to encourage patients to switch to cheaper alternatives, according to GoodRx. But some patients may not be able to take the alternatives which might not be effective for them.
PBMs also are adding more restrictions on the drugs they cover, such as refill-too-soon limits and prior authorization requirements. Today, nearly half of all drugs covered by Medicare plans have at least one restriction.
PBMs say these restrictions control costs by eliminating unnecessary care, according to GoodRx.
But research has suggested that restrictions can affect physicians’ ability to care for their patients, which can end up delaying patient care and increasing overall out-of-pocket costs, according to GoodRx.
Restrictions can also cause patients to abandon their treatment. According to a survey from the American Medical Association cited by GoodRx, 75 percent of providers said prior authorizations lead to patients abandoning treatment.
Read the full analysis here.