Medical Design and Outsourcing

  • Home
  • Medical Device Business
    • Mergers & Acquisitions
    • Financial
    • Regulatory
  • Applications
    • Cardiovascular
    • Devices
    • Imaging
    • Implantables
    • Medical Equipment
    • Orthopedic
    • Surgical
  • Technologies
    • Supplies and Components Index
    • Contract Manufacturing
    • Components
    • Electronics
    • Extrusions
    • Materials
    • Motion Control
    • Prototyping
    • Pumps
    • Tubing
  • MedTech Resources
    • Medtech Events in 2025
    • The 2024 Medtech Big 100
    • Medical Device Handbook
    • MedTech 100 Index
    • Subscribe to Print Magazine
    • DeviceTalks
    • Digital Editions
    • eBooks
    • Educational Assets
    • Manufacturer Search
    • Podcasts
    • Print Subscription
    • Webinars / Digital Events
    • Whitepapers
    • Voices
    • Views
    • Video
  • 2025 Leadership
    • 2024 Winners
    • 2023 Winners
    • 2022 Winners
    • 2021 Winners
  • Women in Medtech
  • Advertise
  • Subscribe

Report: Health Exchanges’ Drug, Doctor Coverage Confusing

April 29, 2014 By Carla K. Johnson, AP Medical Writer

The hunt for a health plan that would cover a particular drug or a favorite doctor proved particularly frustrating for many consumers navigating the new insurance exchanges under the federal government’s healthcare overhaul, according to a report released Monday.

In nearly half the 85 health plans analyzed, it was difficult or impossible for people to determine what drugs were covered, according to the report by market research firm Avalere Health, the first systematic analysis of consumer experience on the exchanges.

The report analyzed health plans in five states that relied on the federal HealthCare.gov website, as well as state-run exchange plans in Washington, D.C., and a dozen states.

A directory of doctors was somewhat easier to find, but there were still some cases in which it was a very demanding search, the report found.

What’s more, the websites typically ranked plans by premium price, which could have misled patients who needed a specific costly medication if it wasn’t covered by the cheapest plan, Avalere spokeswoman Caroline Pearson said.

“It was very difficult for consumers to get a more nuanced view of what their plans covered,” Pearson said. In some cases, a consumer would have to click six times to find drug coverage information. Even worse, no links to lists of covered drugs existed for some health plans.

That forced consumers to search insurance company websites, and, even if they found the covered drug lists, it could be tough to determine which lists went with the exchange plans they were comparing, Pearson said.

“Many chronic conditions rely on medications for management and to keep people out of the hospital,” Pearson said. “If your drug is not covered, then you’re responsible for the full cost or you have to switch to a different drug. The impact on the patient could be several thousands of dollars a year.”

The situation should improve soon, Pearson said, noting the government will require plans on the federal exchange for 2015 to have direct links to lists of covered drugs, also known as formularies.

“It has long been difficult for consumers to tell what prescriptions are covered by different plans, which is why the healthcare law has taken steps to make this information more readily available,” said Health and Human Services spokesman Aaron Albright.

The pharmaceutical company Pfizer Inc. funded the analysis; Avalere maintained control over the content.

Nevada was the only state exchange the report analyzed with a tool to search for drugs so consumers could shop for a health plan based on their medications. But the tool didn’t estimate out-of-pocket costs and was confusing when trying to differentiate between different tiers of medications.

Nevada’s website had other problems, which weren’t mentioned in the report, requiring officials to authorize a special enrollment period for thousands of people who may have tried to sign up but were thwarted by consistent errors. An independent auditor early this month said Nevada’s exchange failed to meet key performance benchmarks and recommended Xerox, its designer, be assessed penalties.

For each website, Avalere analyzed the accessibility of information for five health plans, scoring it by the number of clicks and whether a consumer would have to hunt from an insurance company’s home page or was directed to a dedicated page with the needed information.

“It’s very important that we focus on how to make plan comparison much easier than it was in most exchanges in the first year,” said Robert Krughoff, president of Consumers’ Checkbook, a nonprofit group that developed a model comparison tool with some features that several state-run exchanges are planning to add.

“None of the sites has done a good job helping consumers compare out-of-pocket costs,” Krughoff said. “That results in consumers wasting thousands of dollars a year.”

Related Articles Read More >

Min-Vasive Medtech: Live interviews and audience Q&As with minimally invasive engineers from Edwards Lifesciences, Jupiter Endo and Compremium
This is a screenshot of the remote robotic surgery technical guidelines appearing in the World Journal of Surgery.
New technical guidelines set to advance remote robotic surgery
An illustration of Embolization Inc.'s Nitinol Enhanced Device (NED).
This nitinol vascular embolization device has another shape memory material up its sleeve
A photo of nitinol, a nickel-titanium alloy used for medical devices such as stents, heart valves, catheters and orthopedics.
What is nitinol and where is it used?
“mdo
EXPAND YOUR KNOWLEDGE AND STAY CONNECTED
Get the latest medical device business news, application and technology trends.

DeviceTalks Weekly

See More >

MDO Digital Edition

Digital Edition

Subscribe to Medical Design & Outsourcing. Bookmark, share and interact with the leading medical design engineering magazine today.

MEDTECH 100 INDEX

Medtech 100 logo
Market Summary > Current Price
The MedTech 100 is a financial index calculated using the BIG100 companies covered in Medical Design and Outsourcing.
DeviceTalks

DeviceTalks is a conversation among medical technology leaders. It's events, podcasts, webinars and one-on-one exchanges of ideas & insights.

DeviceTalks

New MedTech Resource

Medical Tubing

MassDevice

Mass Device

The Medical Device Business Journal. MassDevice is the leading medical device news business journal telling the stories of the devices that save lives.

Visit Website
MDO ad
Medical Design and Outsourcing
  • MassDevice
  • DeviceTalks
  • MedTech100 Index
  • Medical Tubing + Extrusion
  • Medical Design Sourcing
  • Drug Delivery Business News
  • Drug Discovery & Development
  • Pharmaceutical Processing World
  • R&D World
  • About Us/Contact
  • Advertise With Us
  • Subscribe to Print Magazine
  • Subscribe to our E-Newsletter
  • Listen to our Weekly Podcasts
  • Join our DeviceTalks Tuesdays Discussion

Copyright © 2025 WTWH Media, LLC. All Rights Reserved. The material on this site may not be reproduced, distributed, transmitted, cached or otherwise used, except with the prior written permission of WTWH Media LLC. Site Map | Privacy Policy | RSS

Search Medical Design & Outsourcing

  • Home
  • Medical Device Business
    • Mergers & Acquisitions
    • Financial
    • Regulatory
  • Applications
    • Cardiovascular
    • Devices
    • Imaging
    • Implantables
    • Medical Equipment
    • Orthopedic
    • Surgical
  • Technologies
    • Supplies and Components Index
    • Contract Manufacturing
    • Components
    • Electronics
    • Extrusions
    • Materials
    • Motion Control
    • Prototyping
    • Pumps
    • Tubing
  • MedTech Resources
    • Medtech Events in 2025
    • The 2024 Medtech Big 100
    • Medical Device Handbook
    • MedTech 100 Index
    • Subscribe to Print Magazine
    • DeviceTalks
    • Digital Editions
    • eBooks
    • Educational Assets
    • Manufacturer Search
    • Podcasts
    • Print Subscription
    • Webinars / Digital Events
    • Whitepapers
    • Voices
    • Views
    • Video
  • 2025 Leadership
    • 2024 Winners
    • 2023 Winners
    • 2022 Winners
    • 2021 Winners
  • Women in Medtech
  • Advertise
  • Subscribe