Survey: Patient Satisfaction is a Barrier to Utilization Management of Drug Plans

Plan sponsors know members are struggling with the barriers placed on them through utilization management and drug benefit design, according to a new survey of benefits leaders. The Trends in Drug Benefit Design Report was sponsored by Rx Savings Solutions and conducted by conducted by PSG.

Morgan Lee

“One of the big findings is the importance of member engagement and member satisfaction that we see that coming through across different topics,” Morgan Lee is the senior director of research & strategy, PSG, said in an interview with Formulary Watch. “It’s encouraging to see that benefit leaders care about their members’ experience.”

PSG surveyed benefits leaders about their perceptions and challenges around high deductible health plans, the role of member experience, formulary strategy, and how the pandemic have shifted plan design priorities.

But while 57% of respondents cited member acceptance as a barrier to trend and utilization management programs, 33% said reducing inappropriate utilization is their top goal outside of managing trend. Additionally, 69% of respondents cited member dissatisfaction as their top challenge with formulary exclusions but 81% use formulary exclusions.

Within high-deductible plans, 22% respondents recognized that affordability of medications prior to deductible being met is challenges. Other challenges included lack of member understanding of health savings account, cited by 19% of respondents, members delaying or foregoing needed care due to deductible amounts, cited by 16% of respondents, and member confusion about deductibles, cited by 12% of respondents. Additionally, only 35% of respondents agreed that high deductible plans were an effective way to manage overall drug trend.

Michael Lonergan

Respondents are not surprised by the friction utilization management and formulary exclusions cause for members, Michael Lonergan, president of PSG, said in an interview. But he pointed to the efforts by benefit plans to become more transparent and help member navigate their plans.

“We’re seeing a two-fold increase in the use of cost-sharing transparency tools,” he said. “This has accelerated through the use of digital tools. Communication with both members and providers is increasing, especially at the point of deciding which treatment to select through the EHR. This can help doctors to know a prior authorization is required or whether there is an alternative.”

In fact, 57% of respondents in the survey promote the use of cost-sharing transparency tools, up from 28% in 2018. Large employers were more likely than smaller employers to promote these tools.

Lonergan said that tools such as Rx Savings Solutions and GoodRx are positive for patients to help provide them information about drug costs.

“Healthcare costs are too high. Plan sponsors are going to continue to be asking members to share in those costs and then empower the members and their provider to make decisions to optimize both the cost and, hopefully, the outcomes,” he said.

Lonergan said that in high deductible plans especially, many people are not engaging their benefit because they may not meet their deductible. “Plans are trying to help those patients navigate the process and make the best decisions.”