Health insurance denials are increasingly delaying prescription drug access, forcing patients to postpone treatment or pay unexpected out-of-pocket costs for medications prescribed by their doctors. Even patients with health insurance are finding it increasingly difficult to obtain prescribed medications on time as insurers tighten approval requirements.
According to a recent analysis by healthcare consulting firm IQVIA, 70% of privately insured patients experienced at least one coverage rejection for a newly prescribed brand-name drug in 2024. The figure means that roughly seven in 10 insured patients encountered at least one obstacle during the prescription drug approval process.
Insurance barriers have continued to rise.
The share of newly prescribed brand-name drugs rejected at the initial coverage stage increased from 57% in 2021 to 70% in 2025. The percentage of patients who still had not received their medication one year after seeking insurance coverage also rose, climbing from 18% in 2021 to 24% in 2024.
The trend is largely driven by stricter prescription drug management policies adopted by insurers.
Even when a doctor prescribes a medication, coverage may be denied if the drug is not included in the insurer’s formulary or if the patient has not received prior authorization. For patients, that means completing another review process even after a medical appointment and receiving a prescription. Coverage decisions can also vary widely depending on the insurer and the specific health plan.
A medication covered under one plan may suddenly be classified as non-covered after a patient changes insurers.
“Patients often assume they can receive a medication immediately once a doctor prescribes it, but many prescriptions are delayed during the insurance approval process,” a representative of Woori Pharmacy in Los Angeles’ Koreatown said. “New drugs and expensive brand-name medications often require prior authorization, and that is where patients are most likely to become frustrated.” The increasingly complicated approval process is also creating a heavier workload for pharmacies. Pharmacists are responsible not only for filling prescriptions but also for confirming coverage and requesting exceptions for medications initially rejected by insurers.
When patients need to continue taking a long-term medication or a specific brand-name drug, pharmacies may work with the prescribing physician to submit medical documentation and request a coverage exception.
Insurance industry representatives say prescription drug approvals depend on several factors, including the patient’s plan, the type of medication, medical necessity, and each insurer’s internal standards. Industry observers also note that Korean American patients may experience coverage denials more frequently because some prefer brand-name medications over generic alternatives. Experts emphasize that an initial insurance denial does not necessarily mean the medication will never be approved.
However, the longer the approval process takes, the greater the risk that treatment will be delayed. The problem is particularly common with high-cost specialty drugs, including medications used to treat obesity, diabetes and immune-related conditions. Patients taking these medications are advised to review their plan’s formulary, confirm whether prior authorization is required and contact their physician or pharmacy quickly if coverage is denied.
