How Patients View Pharmacy Benefit Plans and Management Strategies

Sujit S. Sansgiry, PhD; Samir Sikri, MBA

In This Article


A total of 714 surveys were used for analyses, for a response rate of 63%. Six surveys were not used in the analysis because of inadequate responses. Most surveys (85%) were collected in chain pharmacies. Table 2 summarizes the demographic characteristics of the respondents and descriptive statistics of certain covariables measured.

The mean age of the survey respondents was 39.79 (± 13.88) years. The majority were employed full time (64%), were women (52%), were married (52%), had some college education (54%), had an annual income between $21,000 and $60,000 (46%), and were white (43%). Mean enrollment period in a health plan for the participants was 3.9 (± 4.1) years.

Ninety different plans were identified in the survey, with a higher percentage of patients enrolled in Blue Cross/Blue Shield (20%), followed by Aetna (16%), Humana (8%), and United Health Care (7%). In most cases (72%), survey participants were the primary cardholders.

The domains of patient satisfaction and attitude toward formularies indicated a high reliability score, with a Cronbach α of 0.87 and 0.76, respectively. (A Cronbach α of 0.7 or higher is considered adequate for behavioral research.[20])

The mean patient satisfaction score was 3.5 (± 0.74), which indicated that patients were slightly positive toward their pharmacy benefit plan ( Table 3 ). Among the patients surveyed, more than 70% were somewhat to very satisfied with the medication coverage available through their plan, and 77% were satisfied with the location and choice of pharmacies in the retail network. Half of the patients were satisfied with the way their queries about prescription drug coverage were answered by customer service personnel. Furthermore, 64% were satisfied with the efficiency with which their claims were processed.

The mean attitude toward use of formularies was slightly negative (2.77 ± 0.67) ( Table 4 ). The majority of non-neutral responders felt that formularies limited doctors' choices to prescribe the best medicine (57%), limited access to the best medicines available (49%), affected their ability to take their medication as recommended by the doctor (39%), compromised the quality of their medicines (38%), and resulted in patients receiving less effective medications (34%). Responders disagreed that formularies offered the opportunity to receive the best medicines (37%). However, when asked if they had a copy of their drug formulary, only 25% indicated that they did (data not shown).

Table 4 also depicts the results for patient knowledge regarding formularies. Only 30% were aware of the information covered in their formularies. However, 41% indicated that they were motivated to seek more information regarding formularies. Twenty-eight percent indicated that they were satisfied with the drugs covered on their formulary. Many patients (60%) knew that to receive drugs not on the formulary would mean that they would have to incur higher copayments, and 35% regarded the practice of prior authorization negatively.

When patients were asked to indicate the frequency with which they encountered problems with their pharmacy benefit plan and with their drug coverage, results were mixed ( Table 5 ). Only 18% had never encountered problems with their pharmacy benefit plan, whereas 30% indicated that they had never experienced problems concerning drug coverage.

Results of a Spearman rank correlation analysis between patient satisfaction with the pharmacy benefit plan and perception of formularies are shown in Table 6 . Satisfaction with the pharmacy benefit plan was positively correlated with attitude toward formularies, awareness of information covered in formularies, satisfaction with drug coverage in formularies, and motivation to seek information regarding formularies (P < .05). There was a negative correlation between satisfaction with the pharmacy benefit plan and both the frequency of problems encountered with pharmacy benefit insurance and problems with drug coverage (P < .05). Satisfaction with drug coverage was positively correlated with attitude toward formularies, awareness of information covered in formularies, copayments, practice of prior authorization, and motivation to seek information regarding formularies (P < .05). Also, there was a significant positive correlation between problems associated with the pharmacy benefit plan and problems with drug coverage.

To better understand the factors that predict patient satisfaction with a pharmacy benefit plan, a stepwise (forward) regression analysis was performed. Variables such as attitude toward formularies, knowledge regarding formularies, problems with pharmacy benefits, problems with drug coverage, satisfaction with formulary drug coverage, and demographic data, including age, income, education, and duration of enrollment, were tested in the model. Only 2 of the variables—problems with pharmacy benefits (β = –0.23) and satisfaction with drug cover age (β = 0.22)—were significant predictors of patient satisfaction with the pharmacy benefit plan (R2, 0.22; P < .0001).