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Hidden from View: How Consumers Find Information About Prescription Coverage

The HSM Group

Consumers seeking information about a health plan's prescription drug benefits face a lot of obstacles. How can medication benefits be more accessible and easy to use?

A child peeking through sparse grass with binoculars.

When shopping for health plans, consumers face many challenges in finding information on prescription drug benefits. Publicly posted formularies are often difficult to navigate due to lack of standardization, may be presented in arcane terminology, provide incomplete and inaccurate information, and frequently are not available in languages other than English.

Hidden from View: How Consumers Find Information About Prescription Coverage provides insights into the consumer experience of accessing prescription drug coverage information, pinpoints consumer priorities and preferences for display of relevant benefit information, and identifies opportunities to make that information transparent. Consumer input yielded a range of recommendations for making prescription drug benefit information easier to find and use.

The key findings and recommendations are:

  • Even for consumers with significant prescription drug requirements, the affordability of monthly premiums and other out-of-pocket costs, along with physician selection, trumped questions about drug cost and coverage.
  • In general, respondents were not familiar with many of the terms used routinely in prescription benefit information, such as formulary, prescription drug tier, co-insurance, and preferred drug versus nonpreferred drug. Consumers want materials written in more common, accessible language.
  • There was little awareness of the exceptions or appeals process for obtaining needed medications not listed on a plan's formulary. Those seeking this information had difficulty finding it.
  • Respondents, including Spanish speakers who reported being comfortable reading English, said drug information such as formularies should be available in Spanish and other languages.
  • All consumers, counselors, and agents reported that an interactive, online tool that provides drug cost and coverage information by plan would improve consumer decisionmaking.

The full report is available under Document Downloads.

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