Health insurers cover fewer drugs and make them harder to get
What are formularies in health insurance?
Formularies are lists of prescription drugs covered by a health insurance plan, serving as a guide to determine which medications are preferred and the associated costs4. Understanding your plan's formulary is essential for navigating prescription coverage and costs4. Formularies can vary between insurance plans and may change over time.
Do negotiated drug price benefits reach consumers directly?
Negotiated drug price benefits may not directly reach consumers as lower copays but can help reduce pressure on insurance premiums. Pharmacy benefit managers negotiate with drug companies for lower prices or increased rebates, making drugs a preferred option without prior authorization. This can lead to more affordable medications for payors and patients.
How have drug formularies changed before and after 2020?
Before 2020, drug formularies were shrinking, with the average Medicare formulary covering about three-quarters of all drugs approved by the FDA in 2010, decreasing to a little over half in recent years. Since 2020, formularies have stabilized somewhat, but there has not been an expansion in drug coverage.