Researchers at Weill Cornell Medicine Cornell University Release New Data on Managed Care (Trends in prescription drug coverage restrictions in Medicare, Medicaid, and commercial insurance plans, 2011-2019): Managed Care

2026 MAY 22 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- Investigators publish new report on Managed Care. According to news reporting out of New York City, New York, by NewsRx editors, research stated, “Access to prescription drugs is an enduring challenge in patient care. Payers often rely on coverage restrictions to balance access and cost.”

Funders for this research include National Institute of Aging, National Cancer Institute Grant, Commonwealth Fund, National Institute on Aging, National Institute for Health Care Management, Centers for Disease Control, Arnold Ventures, Information Technology and Innovation Foundation.

Our news journalists obtained a quote from the research from Weill Cornell Medicine Cornell University, “We assessed coverage restrictions for a comprehensive set of branded retail drugs without generic competitors from 2011 to 2019 across the four largest US market segments (Medicare, Medicaid, employer-sponsored, and health insurance exchanges) using CMS and Managed Market Insight and Technology (MMIT) data. Between 2011 and 2019, for the nationally representative beneficiary, the share of drugs excluded from formularies increased from 7.5% to 13.4%, the share of drugs subject to administrative restrictions such as prior authorization or step therapy increased from 18.1% to 43.7%, and the share of drugs on non-preferred tiers decreased from 57.8% to 42.2%. The share of drugs with any coverage restriction increased from 69.7% to 79.0%. Health plans and drugs subject to federal coverage mandates saw much larger increases in prior authorization and increases in non-preferred status.”

According to the news editors, the research concluded: “These dynamics suggest that future research should study the tradeoffs between partial and full coverage restrictions for patient utilization, spending, and well-being.”

This research has been peer-reviewed.

For more information on this research see: Trends in prescription drug coverage restrictions in Medicare, Medicaid, and commercial insurance plans, 2011-2019. Health Affairs Scholar, 2026;4(3).

Our news journalists report that additional information may be obtained by contacting Pragya Kakani, Dept. of Population Health Sciences, Weill Cornell Medicine Cornell University, New York, NY 10022, United States. Additional authors for this research include Michael Anne Kyle, Samantha L. Burn and Luca Maini.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.1093/haschl/qxag059. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

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