New analysis suggests the exchanges didn't provide enough information on drug coverages or providers for consumers to make an adequate—or at least hassle-free—decision.
A report from Avalere Health finds that drug coverage information was often elusive and confusing for consumers shopping on the exchanges, highlighting another challenge for the exchanges under the Patient Protection and Affordable Care Act.
In nearly half of the plans analyzed by the consulting firm, it was difficult or impossible for people to determine what drugs were covered. Specifically, 38 percent of plans had no drug formulary data available, “presenting significant obstacles to consumers who are shopping for insurance and attempting to assess the value of their coverage.” In 11 percent of cases, finding covered drugs was “difficult” or “very difficult.”
Though provider information was more accessible than drug information, it was still nearly impossible for a consumer to find a doctor almost a quarter of the time. Provider information was not available in 16 percent of cases, and “difficult” or “very difficult” 7 percent of the time.
The consulting firm is among the first to analyze the consumer experience on the exchanges post-enrollment. They analyzed 85 plans sold in five states via HealthCare.gov and through 12 states-based exchange websites.
Consumers typically were forced to search—often unsuccessfully—carrier websites for drug information, Avalere Health said.
“HealthCare.gov and several other state websites—including Colorado, Connecticut, Maryland, Minnesota, Nevada and New York—include a link to formularies and provider directories for each plan,” Avalere Health researchers said. “However, the links are not always direct, and in some cases, these links may redirect consumers to the insurer's homepage, which requires consumers to navigate the website, with as many as six clicks, to find the appropriate documents.”
California has the only website that offers consumers a rough out-of-pocket calculator to help gauge expected costs by exchange plan, their research found. Nevada was the only website that includes a drug search function that shows how a person's drug is covered by every plan on the exchange.
Avalere Health Vice President Caroline Pearson said she hopes the noted exchange flaws identified in the report will spur changes in future enrollment to improve transparency and the overall consumer experience.
“Providing understandable and accessible information about the providers and drugs included in exchange plans is essential to helping enrollees make informed purchasing decisions that balance premium against scope of coverage,” Pearson said.
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