This report evaluates how health plans can deliver best-in-class drug coverage and cost tools, ideally where members can add several drug dosage, format and quantity inputs

The strongest healthcare firms offer a single, easily findable drug coverage tool tool where members can add several drug dosage, format and quantity inputs

The 2019 National Health and Nutrition Examination Survey found that nearly 70% of Americans ages 40–79 used at least one prescription drug in the past 30 days, and around 20% used at least five prescription drugs. Couple these findings with lack of drug price transparency, and unhealthy behaviors, drug prices and spending are experiencing exorbitant increases in the United States.

According to a recent Kaiser Family Foundation survey, 78% of the public say the cost of prescription drugs is unreasonable, and 79% see drug company profits as the top contributor to higher healthcare spending. Ultimately, much of the cost burden is placed on private insurers; it is therefore imperative for firms to alleviate some of the pain points between consumers and drug manufacturers.

This Health Plan Monitor Report evaluates how firms in our coverage group present prescription drug costs and coverage functionalities through member site tools. All firms in this report offer at least one drug tool, but they provide varying features and results data. The strongest firms offer a single, easily findable tool where members can add several drug dosage, format and quantity inputs. Seven firms offer integrated member site drug tools, and six link to external prescription benefit manager sites. Best-in-class tools offer a predictive dropdown menu within drug search and automatically populate a member’s plan benefits and location.

Firms fall short when they do not offer drug costs for generic or alterative equivalents to searched drugs and/or drug prices at several retail pharmacies near the member’s location. The highest rated tools offer a drug cost breakdown, which includes the price before coverage, amount covered by the plan, cost to the member, copay or coinsurance amount and amount applied to the deductible. We found several tools also offer additional value-added features and data that advance the user experience and help members understand proper drug use information, side effects and possible interactions.

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