When Insurance Coverage Fails to Deliver Prescribed Medication

Paul Pruitt, Chief Growth Officer at SHARx, argues that the gap between coverage and actual access has become a critical issue. While plans may list a drug as covered, the path to obtaining it is often blocked by specialty pharmacy restrictions and repeated review processes. This friction is most severe for specialty medications, particularly in oncology and autoimmune care, where delays can lead to worsened symptoms and medical crises.

Data from the broader healthcare landscape supports these concerns. A 2025 KFF poll found that 51% of insured adults encountered prior authorization requirements in the previous two years, with nearly half describing the process as difficult. Furthermore, a 2024 American Medical Association survey cited by TIME revealed that 93% of physicians believe prior authorization delays necessary treatment, with 28% reporting that these barriers have caused serious adverse patient outcomes.

For employers, this administrative burden undermines the value of health benefits. When workers spend hours navigating appeals or chasing pharmacy availability, the intended support of a benefit plan fails to materialize. SHARx suggests that benefits leaders must look beyond the price of drugs on paper and address the systemic friction that prevents employees from receiving physician-prescribed care.