Complexity of Health Plan Formularies Challenges Consumers with High Costs
Health plan prescription drug formularies are becoming increasingly complex, posing significant challenges for consumers. According to Matthew Sankey, market regulation manager with The INS Companies, the development of formularies, which are lists of medications approved for coverage by health insurance plans, is heavily influenced by drug manufacturer rebates. These rebates often incentivize higher-cost medications, affecting which drugs are preferred or excluded from formularies. The formularies are divided into multiple tiers, each representing different levels of cost-sharing for patients. Specialty medications, which treat chronic or rare conditions, are growing in prevalence and complexity. The lack of transparency in formularies, coupled with frequent changes and the preference for brand-name drugs over generics, complicates consumer navigation and increases out-of-pocket costs. 
