
- Overly Burdensome Prior Authorization Requirements: Many insurers require that physicians obtain approval from insurance companies before prescribing certain medications, preventing patients from receiving the care they need.
- Overly Restrictive Step Therapy Programs: Insurance companies may compel patients to try and fail cheaper treatments before allowing them to receive the treatment and medication recommended by patients’ doctors or medical professionals.
- Overly Expansive Formulary Exclusions: Insurers and drug companies list prescriptions not covered by their plans. If a patient needs a drug or prescription on that list, the doctor must receive permission from insurers, who decide if they’ll cover it as an exception. The drugs on these lists that are excluded from coverage have grown in recent years.
- Overly Aggressive Non-Medical Switching: In some instances, patients may be forced to switch medication for reasons other than their health. Insurance companies may only cover cheaper alternatives, which could be less effective.
- Adverse Tiering: By placing all or most of the medications used to treat a particular illness on formulary tiers that require the highest patient co-pays, many insurers can discourage certain patient groups from enrolling in their health plans.