Health insurers deny more prescription drug claims: study.

Private health insurers in the US have increased prescription drug coverage rejections by 25% from 2016 to 2023, according to an analysis by Komodo Health. The analysis of over 4 billion claims found that insurers are denying more medical claims, highlighting a trend of increasing insurance denials in the US healthcare system.

Private health insurers in the US have significantly increased prescription drug coverage rejections, with a 25% rise from 2016 to 2023, according to a recent analysis by Komodo Health. The analysis, which examined over 4 billion claims, revealed that insurers are denying more medical claims, indicating a growing trend of insurance denials in the US healthcare system [1].

The analysis found that prescription denial rates have climbed from 18.3% in 2016 to 22.9% in 2023. Among the major health plans, Cigna recorded the highest denial rate of 25% in 2023, while UnitedHealthcare, Aetna, Anthem, and Humana saw increases of 24%, 23%, 22%, and 20% respectively. Only Humana witnessed a slight drop in denial rates over the past two years, with a 20% rejection rate [2].

The rising trend in prescription drug coverage rejections has sparked public scrutiny, with the healthcare industry facing questions about the reasons behind these increases. Experts suggest that the use of artificial intelligence (AI) in claim processing and the high prices of certain medications, such as GLP-1s for weight loss, may be contributing factors [2].

While the analysis does not cover the outcomes of denied claims, industry officials suggest that replacement claims for the same medication are usually approved. UnitedHealthcare, Aetna, Humana, and Anthem declined to comment on the data, while Cigna did not respond to requests for comment. UnitedHealthcare did acknowledge that most rejected claims followed by a subsequent claim for the same drug are typically approved [1].

This trend highlights the need for continued monitoring and regulatory oversight of the healthcare industry to ensure that patients receive the care they need. As the healthcare landscape continues to evolve, investors and financial professionals should closely watch this trend and its potential impact on insurers' financial performance and patient outcomes.

References:
[1] https://seekingalpha.com/news/4469047-health-insurer-claim-denials-the-rise
[2] https://www.beckershospitalreview.com/uncategorized/prescription-drug-denials-from-private-payers-grow-25-in-7-years-report/