How Patients View Pharmacy Benefit Plans and Management Strategies

Sujit S. Sansgiry, PhD; Samir Sikri, MBA

In This Article


A cross-sectional survey design was the basis for this study. A stratified random sampling procedure was used to collect data from patients waiting to get their prescriptions filled at various pharmacies in the Houston metropolitan area. Data were collected in March and April 2003.

Seventy-two chain and independent pharmacies participated in the study. Pharmacy students assisted with data collection, soliciting participants at each pharmacy. If a pharmacy customer declined to be included in the survey, the immediate next person was approached until a quota of 10 respondents per pharmacy was achieved. The number of consumers who declined participation was also noted and used to calculate the corrected response rate. The study protocol was approved by the University of Houston's Committee for the Protection of Human Subjects.

The survey design consisted of 3 sections:

  • Patient satisfaction with their pharmacy benefit.

  • Patient perception of formularies.

  • Demographic information.

The first 2 sections measured satisfaction and perception using previously validated scales ( Table 1 ).[16,17,18] Satisfaction with the pharmacy benefit was measured on the basis of 11 criteria using a 5-point Likert scale (1, very dissatisfied; 2, somewhat dissatisfied; 3, neutral; 4, somewhat satisfied; and 5, very satisfied). Pharmacy customers also were asked about access to medication, choice and location of pharmacies, customer service, and efficiency with which claims were processed.

Patient perceptions of formularies were measured using an 11-item questionnaire, with responses based on a 5-point Likert scale (1, strongly disagree; 2, disagree; 3, neutral; 4, agree; and 5, strongly agree). These items were further divided into 2 subdomains: attitude toward formularies, and knowledge regarding use of formularies. Items pertaining to attitude measured whether use of formularies was perceived to result in less effective medicines, limits on doctors' choices of medication, limits on access to better medications, and compromises in the quality of medications. Items pertaining to knowledge measured patients' awareness of information regarding formularies, motivation to seek information, satisfaction with prescription drug coverage, copayment amounts, and prior authorization practices.

Completed surveys were coded in a database and analyzed.[19] Reliability assessments were conducted on the research instrument by examining the internal consistency of each item with the total domain using Cronbach α. Descriptive, Spearman correlation, and regression analyses were conducted to evaluate the study objectives at a set priori significance level of .05.