Making drug formulary search tools better for patients

There is a real need for patients to have information about out-of-pocket costs and clinical tools being used when it comes to their coverage. A new prescription drug search tool that includes information about cost sharing, prior authorization and step therapy will be available to residents of Washington, D.C., shopping for coverage during the upcoming open enrollment period. These types of tools are important for patients, enabling them to find the best health care plan to meet their needs.

During last year’s open enrollment period, only HealthCare.gov (used by 38 states) and 2 of 13 state-based marketplaces had prescription drug search tools that allowed consumers to search for coverage of their medicines through one integrated search tool. Others were left to look up their medicines across multiple formularies and do their own comparison. DC Health Link’s new offering will allow patients in D.C. purchasing private health insurance to input up to 10 prescriptions and see which plans cover their drugs and the cost sharing that goes with them.

The new DC Health Link tool also improves transparency and information about deductibles. One feature allows people to clearly see plan details, including whether available plans have a separate drug deductible, whether a medication is subject to a copayment or coinsurance and copayment amounts and coinsurance percentages. The tool also clarifies whether the medication is subject to utilization management (like step therapy or prior authorization). During last year’s open enrollment period, consumers on HealthCare.gov had to open multiple webpages and formulary links to determine the cost sharing for their drugs and if their medications would be subject to step therapy or prior authorization.

While progress continues to make marketplace websites more consumer friendly, additional improvements are still necessary to ensure consumers have a clear understanding of the choices in front of them when picking a health plan. Namely, the out-of-pocket estimates calculators are generating still do not account for the cost sharing for the specific prescription drugs entered.  However, by adding a prescription drug look-up tool to their estimators, DC Health Link and HealthCare.gov have shown the remaining states that consumers can be empowered to make important decisions about their health care.  HealthCare.gov and other states could also learn from DC Health Link and make it easier for consumers to see not only whether their drugs are covered by a plan, but also easily see the cost sharing for a medicine. 

Learn more about policy solutions to engage and empower consumers here, and visit AccessBetterCoverage.org for helpful resources to navigate health care coverage.