Drug Prices, Rebates, and Health Plan Coverage Restrictions

Date: February 6, 2026
Journal: JAMA Network Open
Citation: Beinfeld MT, LaMountain F, Phillips GA, Hughes T, Chambers JD. Drug Prices, Rebates, and Health Plan Coverage Restrictions. JAMA Netw Open. 2026 Feb 2;9(2):e2558872. doi: 10.1001/jamanetworkopen.2025.58872. PMID: 41649818; PMCID: PMC12881983.

US health plans routinely restrict coverage of high-cost specialty drugs by using clinical criteria or step therapy. This study explored concerns that drug prices and rebates unduly influence the frequency of these restrictions.

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