IQVIA, a health care consulting firm, released a new study showing that 70% of commercially insured patients were initially denied coverage for at least one newly prescribed brand medicine in 2024. That means seven out of ten patients were forced to delay needed treatments due to insurer policies that prioritize profit over patients.
Insurance denials are the norm – not the exception.
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Nearly a quarter of patients were unable to obtain approval for any new prescriptions for a branded medicine after a year.
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Initial claim rejection rates have climbed 13 percentage points between 2021 and 2025.
What’s driving the spike? Insurers say these tactics manage care. Instead of focusing on patient care, these tactics make patients collateral damage, caught in administrative battles like prior authorization or excessive step therapy, that may delay treatment, add denials or prevent access altogether
Deny first, fix later. Many insurance denials aren’t about what’s best for the patient; they’re about creating red tape to slow down the process. Insurers rely on administrative hurdles that can delay treatment and test whether patients and doctors will push back. When nearly a third of initial denials are overturned within a week, it raises important questions about whether these decisions were genuinely based on medical need versus other factors.
Maze of appeals. As initial rejection rates rose over the past five years, so did the share of patients who never gained approval. In 2024, nearly one in four new attempts were still denied after a year. That is up from 18% in 2021.
Even when approval is eventually granted, it often follows repeated appeals and extra paperwork. Extensive back‑and‑forth between doctors and insurers diverts time from patient care and leaves more patients waiting, switching from their recommended medicine or never starting treatment at all. More than one in four doctors reported that delays from prior authorization have led to a serious adverse event for a patient of theirs.
The path forward: Congress took an important step toward transparency in the supply chain by passing reforms on PBMs that were included in the Consolidated Appropriations Act in January of 2026; the next step is ensuring patients can access and afford the care their doctors prescribe.
It’s time to hold health insurers accountable. Learn more at PhRMA.org/PBMs.
Elise Shutzer
Elise Shutzer currently serves as Vice President of Public Affairs at PhRMA, leading issue communications for key topics including cost and access, hospitals, as well as strategic insights which oversees polling and message research activities. Shutzer is a seasoned leader with extensive experience in public policy advocacy, grassroots and public affairs. She most recently served as the Global Corporate Issue Head for Sustainability and Circularity at ExxonMobil leading advocacy campaigns on plastic waste, the circular economy and other environmental issues. Previously, Shutzer ran the energy and environmental grassroots and coalition development program at The Pew Charitable Trusts, and she spent over a decade at the Dewey Square Group, a prominent public affairs and communications firm.
Elise Shutzer