Health insurers cover fewer drugs and make them harder to get

Insurance companies’ lists of covered drugs, called formularies, are shrinking. In 2010, the average Medicare formulary covered about three-quarters of all drugs approved by the Food and Drug Administration,The GoodRx report is called “The Big Pinch,” because it illustrates how patients are pinched between the drug companies’ high prices and their health insurance companies’ limited drug coverage. GoodRx is an NPR funder.

“Their way to kind of combating the jump in prices or the jump in spending is to really kind of hardball negotiate with drug companies,” says Ballreich. The negotiated prices and rebates don’t typically get passed directly to consumers as lower copays but they can reduce pressure on insurance premiums.

“PBMs make recommendations and assist employers in designing pharmacy benefits that fit their unique patient population needs,” says PCMA spokesman Greg Lopes. “PBMs have a proven track record of creating access to affordable medications for payors and patients.”GoodRx says formularies shrank the most before 2020. Lately, they’ve stabilized somewhat.

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