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Employers' health plans really are getting tougher about which brand-name prescription drugs they cover.
A team at Avalere Health, a health care consulting firm, has published numbers documenting that trend in a new analysis of commercial health plan "formularies," or prescription drug menus.
The Avalere looked at how likely formularies at all types of U.S. commercial plans were to include the available brand-name drugs for six serious conditions: depression, migraines, multiple sclerosis, multiple myeloma, psoriasis and rheumatoid arthritis.
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The team also looked at formulary entries for GLP-1 agonist drugs, which can treat diabetes, obesity and other conditions, and SLGT-2 inhibitors like Jardiance, which can also help people control diabetes.
In 2025, the employer plan formularies included an average of 64% of the single-source, brand-name drugs in the eight categories studied.
That was down from 83% in 2016.
At individual major medical plans sold through the Affordable Care Act public exchange system, the formulary inclusion percentage fell to 37%, from 63%.
Classes of drugs: The Avalere analysts also included the 2025 formulary inclusion rates for each of the eight drug classes studied, without breaking out separate figures for employer plans:
GLP-1 agonists: 75%.
Rheumatoid arthritis drugs: 75%.
Psoriasis drugs: 73%.
Antidepressants: 61%.
SGLT-2 inhibitor diabetes drugs: 58%.
Migraine drugs: 57%.
Multiple sclerosis drugs: 57%.
Multiple myeloma drugs: 45%.
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