Nearly 1 in 3 Prescriptions for Brand-Name Medicines Are…

Nearly 1 in 3 Prescriptions for Brand-Name Medicines Are Rejected by Insurance, JAMA Study Finds Imagine leaving your doctor's office with a prescription, only to discover at the pharmacy that your insurance won't cover it. For millions of patients, this is not an isolated experience. A new study published in JAMA found that nearly one in three first-time prescriptions for single-source brand-name medicines in the United States are rejected because of insurance formulary restrictions. Many patients never receive the treatment originally prescribed or any similar medication. Researchers analyzed pharmacy claims from approximately 1.17 million people who attempted to fill more than 2 million first-time prescriptions for single-source branded medicines between 2018 and 2024. The study evaluated how often prescriptions were rejected due to: Formulary exclusions Prior authorization requirements Step therapy ("try another medication first") What Did Researchers Find? Among all first-time prescription attempts: 68% were approved immediately. 32% were rejected because of insurance formulary restrictions. Of those rejected prescriptions: 38.6% eventually received the originally prescribed medicine. 13% received a different medication in the same therapeutic class. 48.4% received no medication in the same therapeutic class within 90 da