How Patients View Pharmacy Benefit Plans and Management Strategies

Sujit S. Sansgiry, PhD; Samir Sikri, MBA

In This Article


In general, patients had slightly more positive than negative feelings toward their pharmacy benefit plans. Attributes such as choice/location of pharmacies and ability to get the medications prescribed by physicians were considered important by patients. The information and counseling received from the pharmacist was another favorable attribute, which was linked with increased patient satisfaction with the pharmacy benefit plan. These findings are similar to results of a survey showing that access to medications, cost of medications, and retail pharmacy services were the 3 most influential drivers of satisfaction and accounted for 93% of the overall satisfaction index score.[21] Another study found that freedom to choose one's own doctor was the most important attribute, followed by prescription drug coverage and the cost of the doctor visit.[22] Our study results were consistent with these findings.

More patients were dissatisfied with the out-of-pocket costs of pharmacy benefit plans as compared with other services. Considering this result along with the information that the majority of respondents did not have a copy of their formulary and lacked adequate knowledge regarding the drugs covered in the formulary, their attitude toward formularies was slightly negative. Patients who do not have adequate knowledge are often surprised when their copayment is higher. This finding is validated further: the frequency of problems associated with the pharmacy benefit plan and prescription drug coverage was significantly correlated with satisfaction of formulary drug coverage and perception of formularies. In addition, similar results were reported previously on problems encountered with insurance plans and the influence of such problems on enrollees' satisfaction.[23]

Attitude toward formularies as drug management strategies was negative, indicating that patients are still wary of the role that formularies play in controlling health care costs. In general, patients' negative attitudes toward formularies was apparent: patients believe that formularies result in less effective medications being provided, limit choices of physicians to prescribe the best drug, limit access to medications, and thus compromise the quality of their medicines. This negative attitude toward formularies may be attributed to the lack of patient knowledge regarding formulary systems and how formularies function. Many patients did not have a copy of their formulary and were not aware of what information was covered in formularies. The majority were motivated to seek information regarding formularies, indicating that educational interventions are needed to improve knowledge regarding the role of formularies in reducing health care costs.

Results of our study were similar to data from a national poll.[24] The same poll also showed that 47% of patients were concerned that formulary drugs were less effective. Similar results were reported in a different study with a smaller sample size; more than 80% of the patients either agreed or indicated a neutral opinion that a formulary results in less effective medicine.[16] The lack of knowledge regarding formularies may increase the number of negative encounters experienced by patients and thus lead to reduction in the level of patient satisfaction with pharmacy benefit plans.

A patient's motivation to seek information on formularies and drug benefits should not be overlooked by health plan providers. Health plans should enhance their efforts to provide easy-to-understand information regarding formularies and the benefits available from their pharmacy benefit plans. Educational interventions developed specifically with respect to the role of formularies to reduce health care costs may increase knowledge and reduce patient skepticism toward such drug management strategies. Previous studies have shown that understanding complex health insurance programs is difficult for patients and may take repeated exposures with a multifaceted approach to improve perceptions.[25]

Educational interventions should be continuous, with information specific to each patient's formulary and drug coverage and the role each plays in reducing a patient's out-of-pocket costs. Information can be provided using handbooks, pocket guides, or national direct-to-consumer advertisements. This information can be directly disseminated by health insurance companies or in participative arrangement with pharmacies to improve patient knowledge and compliance with formularies.

Although the results of this study are preliminary, the correlation analysis showed that there was a significant association between patient satisfaction with pharmacy benefit plans, satisfaction with drug coverage, and attitude toward formularies. Similar results were reported by a study that evaluated patients' attitudes toward drug management strategies.[17] However, patients' attitudes toward prescription drug coverage and perception of formulary medications were shown to have no effect on medication utilization in a previously reported study, which used claims data to evaluate medication utilization and formulary compliance rates.[26] It would be interesting to further pursue this approach with a prospective study.

Patient attitudes not only affect certain perceptions about their drug benefit plan but also may lead to modified behavior, such as noncompliance with new prescriptions and renewals and lack of adherence to medication therapy.[27] In addition, patients may remember their experiences, especially problems associated with drug coverage, which may affect negatively their satisfaction with a pharmacy benefit plan. Such dissatisfaction may also reduce health plan enrollment rates.