Alliance for Patient Access / IfPA’s Patient Access Policy Blog / Insurance Exchanges Lack Clarity on Rx Coverage, Study Finds

Insurance Exchanges Lack Clarity on Rx Coverage, Study Finds

by Amanda Conschafter, Blog Editor

Determining how an exchange-sold insurance plan covers your prescription medications may be harder than you’d expect, a new study reveals.  Researchers at Avalere Health surveyed plans sold in 17 states, including five through the federal HealthCare.gov site and 12 through individual state websites, to assess the transparency of information on both provider networks and drug formularies.  Their findings, which coincide with the end of open enrollment for the exchanges’ first year, show that only 52 percent of plans surveyed have very or moderately accessible information on prescription drug coverage. 

Accessibility ratings for the study reflect how directly patients can find information on drug formularies.  Thirty-eight percent of programs surveyed had no link to drug formularies. Among those states that did, some redirected patients to insurers’ websites and required navigating as many as six clicks from the original link to find the information required.

Navigation this complex presents opportunities for patients to become confused or distracted.  It also suggests that patients assessing these states’ insurance plans may not have a clear understanding of the prescription drug coverage provided.

Researchers also considered the usefulness and availability of online tools for enhancing patients’ understanding of how different plans work.  They found that Nevada is the only state that offers a drug search function, allowing patients to compare how plans cover specific medications.  Meanwhile, California’s website is unique in providing a calculator for determining out-of-pocket costs.

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