“Prescription drug denials by private insurers in the United States jumped 25 percent from 2016 to 2023, according to a new analysis of more than four billion claims, a practice that has contributed to rising public outrage about the nation’s private health insurance system,” Sarah Kliff writes over at The New York Times. “The report, compiled for The New York Times by the health analytics company Komodo Health, shows that denial rates rose from 18.3 percent to 22.9 percent. The rejections went up across many major health plans, including the country’s largest private insurer, UnitedHealthcare. The data offers a rare look into the largely hidden world of rejected insurance claims. While some government-funded health plans are required to publish their denial rates, most private insurers keep that information confidential. Komodo draws from private databases that collect denial details from pharmacies, insurers and intermediaries. Claim denials are ‘quite opaque, and a lot of decisions are made by private actors,’ said Dr. Aaron Schwartz, a health economist at the University of Pennsylvania. ‘There are legitimate questions about whether they are appropriate.’” Sarah Kliff, “Health insurers are denying more drug claims, data shows,” The New York Times.
