Differences in managed care drug formularies: what can consumers learn?

Area of Science:

• Health Economics
• Pharmaceutical Policy
• Health Services Research

Background:

• Pharmaceutical coverage is a critical component of health plan design.
• Managed care formularies play a key role in determining patient access to medications.
• Understanding formulary generosity is essential due to patient variability in drug response.

Purpose of the Study:

• To develop an objective measure for assessing drug coverage generosity in managed care formularies.
• To analyze the relationship between formulary generosity and health plan member satisfaction.

Main Methods:

• Developed a novel measure of formulary generosity, considering both the number of drugs and exclusion of expensive options.
• Examined the correlation between this generosity measure and subscriber-reported satisfaction with health plans.

Main Results:

• Significant variation exists among health plans in their offering of pharmaceutical access.
• Formulary generosity, as measured, showed a weak correlation with overall health plan member satisfaction.
• Exclusion of more expensive drug options did not appear to significantly impact member perception of quality.

Conclusions:

• Objective measurement of formulary generosity is feasible and reveals plan-level differences.
• Health plan member satisfaction is not strongly driven by the generosity of pharmaceutical coverage alone.
• Further research may explore other factors influencing member satisfaction beyond drug formulary design.