SANTA MONICA, Calif. — A new GoodRx report that reveals the uneven landscape of prescription coverage and restrictions across U.S. insurance – be it commercial, Medicare, or Medicaid. The new report paints a stark reality that for many Americans, the real hurdle to treatment isn’t just medication prices — it’s navigating the complex policies and restrictions embedded in their health plan that dictate the cost they pay at the pharmacy counter.
“Our research shows that unfortunately, having insurance doesn’t guarantee meaningful or easy access to medications. Whether it’s commercial, Medicare, or Medicaid, Americans are facing growing barriers – from medications not being covered to complex approval processes – that delay or block treatment,” said Tori Marsh, senior director of research at GoodRx. “To help address this stark reality, GoodRx complements insurance by filling the gaps in coverage and helping consumers navigate these challenges.”
Key report findings include:
- Prescription insurance coverage is less comprehensive and more restrictive – often requiring things like prior authorizations or step therapy – that can delay or deny care coverage for many Americans, across all insurance plans.
- Medicare covers the least amount of medications, and Medicaid imposes the most restrictions on accessing covered medications.
- Nearly half of Medicare-covered drugs have restrictions, including those in federally protected categories (e.g., cancer, HIV meds).
- Medicaid is the most generous in coverage (97%), but also the most restrictive (63% of drugs have hurdles to access).
- For the average commercial insurance, 21% of medications have no coverage and over 1 in 3 come with restrictions.
- Over 30% of consumers facing insurance restrictions report skipping, delaying, or switching treatments.
