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Reduced Drug Coverage Leaves Americans Struggling Medically and Financially

Americans are increasingly facing higher costs and reduced coverage for prescription drugs, a trend exacerbated by recent studies in healthcare. According to findings by GoodRx, which analyzed over 3,700 Medicare Part D plans from 2010 to 2024, health insurers are covering fewer medications while imposing stricter coverage restrictions, all while raising costs for consumers.

In a climate of soaring inflation, healthcare expenses are becoming more burdensome. The Centers for Disease Control and Prevention reports that millions of adults are forgoing prescribed medications due to cost concerns, resorting to strategies like skipping doses or delaying refills.

Tori Marsh, GoodRx’s research director, highlights several ways insurers are increasing costs for Americans:

  • Coverage has decreased by 19%, with plans covering only 54% of prescribed drugs in 2024 compared to 73% in 2010.
  • The number of drugs with restrictions has risen by 23%, including quantity limits and step therapy requirements.
  • Patients often face challenges like prior authorization and high out-of-pocket costs, leading many to abandon their prescriptions altogether.

The financial burden extends beyond coverage reductions. Deductibles have nearly doubled over the past decade, making medications less accessible even when covered by insurance. Additionally, coinsurance for high-cost drugs further strains consumers’ budgets.

Outside of insurance, escalating drug prices, supply chain disruptions, and limited pharmacy access contribute to higher out-of-pocket spending. Despite efforts like President Biden’s initiative to cap insulin prices, challenges persist in ensuring affordability and accessibility.

Marsh emphasizes the need for industry-wide collaboration to address these issues effectively. She suggests practical steps for consumers, such as comparing prices across pharmacies, exploring generic alternatives, and utilizing discount programs like GoodRx.

Ultimately, navigating these challenges requires proactive consumer awareness and engagement with available resources to mitigate the financial impact of prescription medications.

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