Insurance deny your prescription? You’re far from alone, Hopkins study finds

If you’ve had trouble filling a brand-name prescription at the pharmacy lately, join the ever-growing club.

A new study from Johns Hopkins University found 1 in 3 is initially rejected and the denials climbed 67% from 2018 to 2024. Almost half of these prescriptions weren’t filled within the next 90 days.

Fueling the surge are new blockbuster weight loss drugs, such as Wegovy and Ozempic, which often come with limits or are not covered at all. They also don’t have cheaper generic alternatives.

Researchers say the findings should spur deeper discussion about how to balance prescription drug spending and access to treatments — a process Maryland has begun.

“Maybe you shouldn’t have gotten it, or maybe you gave up because it was a hassle,” said Joseph Levy, an assistant professor in Hopkins’ department of health policy and management and lead author of the study.

“At least some of the time it’s likely not good you didn’t get the drug.”

Levy said such denials have been known for some time but it was important to find data to show the scope of the problem.

He and other researchers from Hopkins and the American Enterprise Institute analyzed more than 2 million brand-name prescriptions with no generic alternatives across commercial insurance, Medicare and Medicaid. The results were published July 9 in the journal JAMA.

Levy said they focused on brand names for their outsize impacts. The Association for Accessible Medicines found they account for just 10% of total prescriptions but about 88% of spending.

The popular weight loss drugs, called GLP-1s, had the highest rate of rejection, at 85%, with insurers seeking to limit their exploding costs as government regulators expanded their approved uses.

Maryland officials have been concerned about how drugs have impacted the cost of government and private insurance and family budgets. In 2019, the state became the first to create a Prescription Drug Affordability Board.

In its first moves this year, the board capped what state and local government insurance plans would pay for a common diabetes drug, Jardiance, and Ozempic in their workers’ plans beginning in 2027. Commercial plans will follow a year later. The board is expected to continue evaluating drugs.

Levy, who previously served as a board member, said it remains to be seen if insurers add the drugs to their formularies — and if drug companies are willing to accept the price.

Benjamin Schmitt, president of the Howard County Education Association, the union representing teachers and other staff, testified to the board in May that the county school system dropped coverage of GLP-1s for weight loss only in its plan when drugmakers refused to bargain on the monthly cost per person of about $1,000.

The county said the extra $10 million a year would have led to a 20% premium increase.

“I’m glad they added Ozempic, though it’s just one weight loss drug and it’ll take time to kick in,” Schmitt said in an interview about the drug board.

“I’m waiting with bated breath to see how this goes and if it moves the needle on cost.“

Over time, the savings to insurance plans and the public should be immense, and access to drugs should expand, said Vincent DeMarco, president of the advocacy group Maryland Health Care for All Coalition.

An analysis commissioned by the group found limits on Ozempic alone could save $165 million when caps are fully implemented.

“We have to deal with the underlying problem,” he said of the huge costs to plans and the public.

“The Prescription Drug Affordability Board took two big steps to make that happen with Jardiance and Ozempic.”