What question did this study set out to answer?

The aim is to assess trends in prescription drug coverage restrictions in major U.S. insurance plans over time.

March 13, 2026Health Affairs ScholarOpen Access

Trends in Prescription Drug Coverage Restrictions in Medicare, Medicaid, and Commercial Insurance Plans, 2011-2019

View Full Paper

Ask AI

Bookmark

The aim is to assess trends in prescription drug coverage restrictions in major U.S. insurance plans over time.
Analyzed coverage restrictions for branded retail drugs without generic alternatives from 2011-2019.
Used data from CMS and Managed Market Insight and Technology (MMIT).
Focused on four major market segments: Medicare, Medicaid, employer-sponsored, and health insurance exchanges.
Share of drugs excluded from formularies increased from 7.5% to 13.4%.
Administrative restrictions, like prior authorization, rose from 18.1% to 43.7%.
The proportion of drugs on non-preferred tiers decreased from 57.8% to 42.2%.
Overall coverage restrictions increased from 69.7% to 79.0%.
Health plans with federal coverage mandates experienced greater increases in restrictions.

Authors

No takes yet. Share an insight, caveat, or question.

Analysis shows increasing prescription drug coverage restrictions in Medicare, Medicaid, and commercial plans, indicating a complex tradeoff.

Kyle et al. (2026) studied this question.

View Full Paper

Ask AI

Bookmark

Analysis shows increasing prescription drug coverage restrictions in Medicare, Medicaid, and commercial plans, indicating a complex tradeoff.