In February, the Trump administration launched TrumpRx, a government website that provides prescription drug discounts to consumers. This brief examines issues that may impact consumers, especially those with private insurance, who access drug discounts through TrumpRx.

This brief analyzes federal transparency data published by CMS on claims denials and appeals for Marketplace plan offered on HealthCare.gov in 2024, and finds insurers denied 19% of in-network claims. Consumers rarely appeal denied claims.

New KFF polling explores the challenges beyond costs that people with insurance face in navigating the health care system. People cite prior authorization review as their top problem by a wide margin, with a third saying prior authorization requirements are a “major burden.

Medicare Advantage insurers made nearly 53 million prior authorization determinations in 2024, up from 49.8 million in 2023. They fully or partially denied 7.7% of the prior authorization requests they received. Just 11.5% of all denials were appealed, and the initial denial was overturned in most of those cases.

This brief examines state policies related to prior authorization processes in Medicaid managed care and includes findings about how states approach prior authorization decision timeframes, electronic denial notices, and access to external medical reviews, all as of July 1, 2024.

This brief examines the final CMS regulations governing prior authorization in Medicare Advantage, Marketplace, Medicaid, and other plans, how they might address some current consumer concerns, and some issues that remain.