Prescription Denials Rose 25% in Seven Years. Here Is What the Data Actually Shows.

A Komodo Health analysis published in July 2025, based on a review of more than 4 billion insurance claims, found that prescription denials by private insurers increased by approximately 25 percent between 2016 and 2023. The New York Times reported on the findings, drawing attention to which drug categories and insurer types were most associated with the trend.

This brief translates that data into patient-facing terms: what the increase means, which medications are most affected, what is driving the growth, and what you can do if you receive a denial.

Background

Prior authorization has existed as a cost-control mechanism since at least the 1980s, when managed care organizations began requiring physician approval before covering certain medications and procedures. For decades, the system operated largely in the background. Most denials affected a narrow category of expensive specialty drugs, and the overall denial rate, while frustrating, was not a dominant feature of the average patient's experience.

That changed over the period Komodo Health examined. From 2016 to 2023, as commercial insurance consolidated, pharmacy benefit managers expanded formulary control, and payers adopted algorithmic review systems, the rate at which commercially insured patients were denied prescription coverage climbed measurably and consistently.

What the 25% Increase Actually Means

A 25 percent increase in denial rates does not mean that 25 percent of all prescriptions are now denied. Prior authorization applies to a subset of prescriptions, primarily specialty, brand-name, and certain controlled medications. The 25 percent figure describes the change in how often those subject-to-review prescriptions result in a denial, not the baseline denial rate for all drugs.

Still, the implications are significant. KFF analysis of Medicare Advantage plans, which share oversight characteristics with commercial plans, found that MA plans issued 35 million prior authorization requests in 2021. Even a small percentage increase in denials across that volume translates to millions of additional patients facing access barriers annually.

Ellen can help you understand your denial and build an appeal. Start here →