How shrinking drug coverage is putting Americans in a bind

Paying more for less is a recurring theme for Americans these past few years, and it’s even true in health care, a new study shows.
Health insurers are covering fewer drugs and putting more restrictions on their drug coverage but are still raising costs for consumers, prescription drug comparison site GoodRx found after reviewing more than 3,700 Medicare Part D plans from 2010 to 2024.
At a time when Americans are already squeezed by inflation that has soared over the past few years, the cost of staying healthy is becoming more prohibitive. The Centers for Disease Control and Prevention said 9.2 million adults reported not taking medications as prescribed because of cost, employing such strategies as skipping doses, taking less than the prescribed dose or delaying filling a prescription.
“The high cost of medications can force people to make difficult choices between prioritizing their health and managing other essential expenses,” said Tori Marsh, GoodRx research director.
Insurers are doing a few things that are making medications more expensive for Americans, Marsh said, including:
Patients either “jump through hoops” to get their medications covered, pay for it themselves or delay taking or abandon their medication completely.
If consumers pay, they pay the drug’s cash price, “which is typically unaffordable,” Marsh said. “It’s no wonder many patients end up abandoning their prescriptions.”
Even if insurance helps cover a medication’s cost, increasing copays, co-insurance and deductibles can still make the prescription financially out of reach.
Over the past 10 years, the average deductible for a single enrollee almost doubled, to $1,644 from $917, nonprofit researcher KFF said. Additionally, more medications are being classified as high-cost drugs, which means more out-of-pocket costs for patients.
Patients usually pay a flat, inexpensive co-pay for lower-cost medications, but a percentage (coinsurance) of a high-cost drug. The more expensive the drug, the more you pay.
According to an American Medical Association survey, 80% of health care professionals reported that prior authorizations also lead to patients abandoning treatment because of the hassle and delays in care they can cause.
Soaring prescription drug prices and poor access to medication because of supply chain bottlenecks and pharmacy “deserts” are also pushing up Americans’ out-of-pocket drug spending, Marsh said.
The list price for all prescription medications have jumped 37% since 2014, and consumers are bearing the brunt of that, she said.
At the same time, more than 40 million Americans lack proper access to a pharmacy, and 20% of Americans had an out-of-stock prescription this year.
“Fifty-one million Americans leave prescription medications unfilled every month,” Marsh said.
“Policymakers are taking steps to improve medication access and affordability, but given the complexity of our health care system, changes must happen across the industry,” Marsh said. “Collaboration between the many health care players is critical for getting people the medication they need at a price they can afford.”
For example, she noted that after the government capped insulin prices at $35, consumers had a hard time getting their medication at that price. Some Medicare plans dropped some insulin coverage.
There has been progress with drug manufacturers offering patient assistance programs co-pay cards for brand medications, but insurers have added barriers, Marsh said. “The largest insurance restriction increase happened in 2019, and we’ve continued to see incremental increases every year since,” she said.
More price transparency also would help, she said.
“People agree to tests, labs, and medications without any understanding of the out-of-pocket costs,” she said. “Even when given an insurance estimate upfront, the margin of error can be extreme. This leads to people taking cost-saving measures such as skipping doses or appointments, delaying a prescription refill, or even taking less medication than prescribed. It doesn’t have to be this way.”
Price checker:Medication prices: See what pharmacies pay for common drugs
Some tips to lower your prescription drug bill, according to experts, include:
Medora Lee is a money, markets, and personal finance reporter at USA TODAY. You can reach her at [email protected] and subscribe to our free Daily Money newsletter for personal finance tips and business news every Monday through Friday morning.