Predictors of Satisfaction of Health Plan Members With Prescript
Purpose: Relationships between sociodemographic and health plan characteristics and health plan member satisfaction with prescription drug benefits were studied.
Methods: A survey was mailed in November 2002 to a stratified random sample of 14,141 people covered by a pharmacy benefit management company (PBM) who had made at least one prescription drug claim during the second quarter of 2002. Survey recipients had commercial health insurance and were 19-64 years of age. Participants were stratified by drug benefit plan design (two-tier copayment system, three-tier copayment system, coinsurance, or closed formulary). The survey contained 39 questions covering satisfaction with the prescription drug benefit, health-related attitudes and knowledge, and experience with the benefit. Predictors of satisfaction were examined by using logistic regression with probability weights.
Results: A total of 3819 surveys were returned (response rate, 27%). Respondents were more likely to be mail-order pharmacy users and less likely to be enrolled in a plan with a closed formulary. Out-of-pocket costs were viewed as the most important feature of the pharmacy benefit. In the logistic regression, higher copayments, coinsurance, closed formularies, intensive managed care, large health care premiums, a recent increase in copayments, and a recent denial of coverage were associated with lower satisfaction with the prescription drug benefit. Excellent health and use of mail-order pharmacy were associated with greater satisfaction.
Conclusion: The extent to which health plan members served by a PBM had to share drug costs was the strongest determinant of satisfaction with the prescription drug benefit.

While the prescription drug benefit is one of the most frequently used health care benefits in the United States, little is known about how satisfied consumers are with it or how sociodemographics and health plan design affect satisfaction. Understanding the predictors of satisfaction can help plan sponsors identify opportunities to minimize member dissatisfaction while simultaneously managing prescription drug costs. Satisfied members are more likely to remain in a plan and recommend it to other consumers.

Previous research on the broader topic of health plan satisfaction has shown sociodemographics, health plan characteristics, and selected patient characteristics, such as expectations and knowledge of the benefit, to be predictors of satisfaction. Published research on satisfaction with prescription drug benefits is limited to two studies. Desselle conducted interviews at 10 randomly selected pharmacies in Pittsburgh and found that having a choice of health plans and being less familiar with the prescription drug benefit were associated with greater satisfaction with the benefit. Nair sampled Medicare and commercial enrollees with chronic disease in one managed care plan and found that enrollees in plans with three-tier copayments were less likely than two-tier-plan enrollees to report that their prescription drug coverage was good.

The objective of our study was to examine the relationships between sociodemographic and health plan characteristics and satisfaction with prescription drug benefits in a large, geographically diverse population. The sociodemographic variables in this study included patient characteristics (e.g., knowledge of the pharmacy benefit and use of mail-order pharmacy) for which previous research has been limited and examined several previously unstudied but potentially important plan-design characteristics, including generic drug policy, type of cost sharing (e.g., copayments versus coinsurance), and history of denial of drug coverage or of copayment increases.