Designing a Pharmacy Benefit for the New Public Health Exchange Consumers

Feb 12, 2013
An Express Scripts commissioned study that takes a closer look at the public exchange consumer.

STUDY - Healthcare Reform Solutions: Designing a Pharmacy Benefit for the New Public Health Exchange Consumers

Click to download the PDF.


As health plans participate in the public health insurance exchanges, they are looking for ways to optimize their plans to attract new consumers while managing costs and promoting healthy outcomes. It’s an unprecedented opportunity that requires fresh thinking about the new public exchange consumer. Little is known about the buying behavior of this risky and potentially costly group, particularly around their pharmacy purchase behavior and usage patterns. Therefore, the role that pharmacy benefits plays is critical in helping health plans design pharmacy solutions for this population. In November 2012, Express Scripts commissioned an independent, custom, consumer market research study to gain a better understanding of the new public exchange consumer and how pharmacy benefits can influence plan selection in the public exchange marketplace.

Key Findings

This study yielded two critical insights. The first – consumers are willing to trade access for premium savings.  The second – being highly subsidized effectively raises the importance of factors other than premium for plan election. 

In addition, this study established seven key findings:

  1. Consumers will select a narrower pharmacy network.
  2. Home delivery is acceptable for most consumers.
  3. As subsidies neutralize premiums, pharmacy factors more heavily influence plan choice.
  4. Uninsured consumers are less sensitive to drug copayments.
  5. Most consumers will accept a $100 drug deductible.
  6. High medication utilizers have similar preferences as healthier consumers.
  7. Consumer preferences are similar across the country and among employer groups.

About this Study

This study evaluated consumer preferences for a variety of pharmacy benefit bundles among three groups:

  • The uninsured
  • Those who currently purchase insurance directly on their own
  • Those who currently receive health insurance through their employer

The web-based, conjoint study had 2,765 participants, aged 18 to 64, with heavier weighting in California, New York, Pennsylvania, Ohio and Tennessee, and excluded those currently with coverage through Medicare or Medicaid.

This study was conducted by Deft Research, LLC. Express Scripts was not identified as the sponsor.