Drug benefit design is increasingly complex. The number of drugs on the market is growing, and decisions about program structure, cost sharing, formulary design, and clinical and trend management programs are more numerous and complicated than ever. At the same time, patients are becoming more engaged in their health care planning and decision-making.
Plan members are the end users of drug benefits, the design of which can impact their finances and their health. Accordingly, it’s critically important for benefits leaders to make drug benefit design decisions with members in mind, effectively educate members about their benefits, and provide resources to help their members navigate these benefits. Members must be recognized for what they are – important stakeholders who should be engaged and informed about their health care benefits.
In the recent Pharmaceutical Strategies Group (PSG) 2022 Trends in Drug Benefit Design Report, which details traditional (non-specialty) drug benefit trends and strategies, drug benefit leaders highlighted both the importance of and challenges with member satisfaction and engagement. Survey respondents recognized that member engagement is critical:
Member Experience: A Challenge for Plan Sponsors
Although member acceptance, engagement, and satisfaction are recognized as important, drug benefits tend to be complex and hard for members to understand. Members may have trouble understanding what is and isn’t covered by their plan (and why), how much cost sharing is expected of them, and where to get information and assistance. This lack of understanding can keep them from effectively using their benefits. Members may also be dissatisfied with the types of plans available to them, constraints on which drugs are covered and which channels they can use to obtain their medications, their amount of cost sharing, and any other trend and utilization programs that put boundaries or barriers in place.
The drug benefit leaders who responded to this survey identified concerns around member experience in several key areas:
1. High-deductible health plans
High-deductible health plans (HDHPs), which the Internal Revenue Service defines as plans with a deductible of at least $1,400 for an individual and $2,800 for a family, aim to decrease the use of low-value care and encourage consumers to actively consider both cost and quality when making health care decisions. When drug benefit leaders were asked the top challenge they face with HDHPs, they emphasized member-related concerns — the 3 challenges that received the highest percentage of responses were all related to member experience.
2. Trend and utilization programs
Member acceptance is a primary barrier for trend and utilization programs. In the 2022 survey, 57% of respondents said that member acceptance is a barrier for trend and utilization programs, compared to only 44% when the survey was last conducted in 2018. This represents a substantial increase in experience of this issue in recent years.
3. Formulary exclusions
Member dissatisfaction was the number one challenge when it comes to formulary exclusions, with 69% of survey respondents indicating member dissatisfaction was their top challenge in this area. Although member dissatisfaction was the most commonly selected top challenge in all respondent groups, rates of choosing this response ranged from 46% among health plan respondents (who may have less direct engagement with members) to 77% among employer respondents.
Emphasis on Educating and Engaging Members
PSG’s survey results show an appetite among plan sponsors for increasing member engagement and providing more education to members about their drug benefits, with the goals of increasing acceptance and satisfaction and promoting appropriate use of benefits. The report highlights that plan sponsors are looking for innovative, effective strategies to improve member engagement and satisfaction. Drug benefit leaders said they want to see better approaches and new tools to educate and engage members.
One such strategy is the promotion of cost-sharing transparency tools, which can help members plan and manage their cost sharing. In the 2022 survey, 57% of respondents said they promote these tools, up from 28% in 2018. This large increase is likely due to increases in the number of tools available and in education about these tools in recent years. Tools like Rx Savings Solutions and GoodRx can provide value to members, and ongoing attention and innovation to enhance member engagement and education is warranted.
Download Trends in Drug Benefit Design Report