Insurance coverage for prescription drugs has changed drastically in recent years, with formularies shrinking and making it harder for patients to access necessary medications. Research by GoodRx shows that Medicare formularies now only cover just over half of FDA-approved drugs, compared to three-quarters in 2010. Commercial insurance plans likely cover even fewer drugs. Patients now face more hurdles to access covered drugs, with half requiring prior authorization. These limitations serve a business purpose, giving negotiating leverage to insurance companies and pharmacy benefit managers. While negotiated prices and rebates may not directly reduce consumer costs, they can help lower insurance premiums. Consumers looking for more generous drug coverage may need to shop around for higher premium plans. Despite some stabilization in formulary shrinkage, drug coverage has not expanded in recent years.