Modern medical research has developed many amazing drugs but some of them are extremely expensive.
Health Insurers Are Denying More Drug Claims, Data Shows
Offering a rare glimpse inside the hidden world of rejected insurance claims, new data shows a steady uptick among major private insurers.
By Sarah Kliff, The New York Times, July 18, 2025
Prescription drug denials by private insurers in the United States jumped 25 percent from 2016 to 2023, according to a new analysis of more than four billion claims, a practice that has contributed to rising public outrage about the nation’s private health insurance system.
The report, compiled for The New York Times by the medical data company Komodo Health, shows that denial rates rose from 18.3 percent to 22.9 percent. The rejections went up across many major health plans, including the country’s largest private insurer, UnitedHealthcare…
Decisions to deny claims are not always made directly by health insurance plans. Much of that work is done by pharmacy benefit managers, middlemen who are contracted to manage prescription drug coverage. Large employers can also play a role, dictating which drugs they want covered for their workers in their provided health plans…
Private plans now have a slightly higher denial rate than traditional Medicare. The rate of rejected claims is still lower than Medicaid, which covers low-income Americans, and private Medicare Advantage plans…
Pricey new GLP-1 weight loss drugs like Ozempic, and other blockbuster medications, may have led insurers to increase restrictions on other drugs as they grappled with ways to offset those growing costs… [end quote]
This is a real quandary. Nearly 1 in 3 adults (30.7%) are overweight. More than 2 in 5 adults (42.4%) have obesity. About 1 in 11 adults (9.2%) have severe obesity.
The cost of Ozempic can vary, but without insurance, it typically costs around $997.58 per month for a single pen. (The drug costs just $59 per month in Germany, $122 per month in Denmark and $155 per month in Canada.) Wegovy, specifically marketed for weight loss, carries a list price of $1,349 per month.
Some cancer chemotherapy drugs are far more expensive.
Insurers have a strong incentive to deny patients prescription drugs, especially name-brand drugs for which cheaper generic alternatives are available.
This situation impinges on every family and has Macroeconomic impact as well as impacting the pharmaceutical companies which market the drugs.
Wendy
