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Assessing Patients' Knowledge of Prescription Insurance

Stephanie Marsino, Gretchen Helfrich, Pharm.D. Candidates; Abby Kahaleh, B.S. Pharm., M.S., MPH, Ph.D., Ohio Northern University

The purpose of this study was to obtain information regarding patients' understanding of their prescription insurance. Specifically, we compared patients' knowledge about their prescription insurance to pharmacists' perceptions of patients' knowledge. A secondary objective was to develop an educational tool that could enhance patients' knowledge. Finally, we aimed to educate patients on their prescription insurance to improve health outcomes.

There has been relatively little research completed on this topic to date. Past research focused on patients' understanding of their hospital coverage, doctors' visits, and other outpatient services.(1,2) Marquis (2) found that after patients were given paperwork and a personal explanation of benefits, they showed a better understanding of their benefits.(2) Sansgiry et al studied consumer knowledge and perceptions of formularies. They found that overall satisfaction positively correlated with: attitudes towards formularies; awareness of information covered in formularies; co-pay policies; satisfaction with drug coverage in formularies; and motivation to seek information regarding formularies. They also noted that more than 80 percent of consumers in their study reported some type of problem with their prescription insurance plan and/or drug coverage.3 Thus, we believe that increased awareness about prescription insurance will allow patients to have a more positive experience in their community pharmacy, and to make more informed and economic choices in their health care.

The study design was cross-sectional. We used questionnaires as a method for data collection. Patients and pharmacists were given a handout with answers to commonly asked questions relating to prescription insurance. Self-administered questionnaires were then distributed to patients and pharmacists in community pharmacies in New York and Ohio. Thirty-one patients and 29 pharmacists returned the survey. The patient questionnaire assessed current prescription insurance knowledge, the desire to learn more about a variety of insurance topics, and the usefulness of the informational handout. The pharmacist questionnaire assessed patient knowledge of prescription insurance, as well as time spent discussing prescription insurance with patients.

Results showed that the majority of patients expressed the desire to learn more about their prescription drug coverage. Patients agreed that the handout was useful and increased their knowledge about prescription drug plans. Before reading the handout, patients knew the least about the following subjects: formularies; vacation supplies; and lost/spilled medications. However, after reading the handout, most patients had only little to some desire to obtain more information. This may be attributed to the fact that we had already given them the informational handout and it had theoretically answered all of their questions. While most patients thought they were knowledgeable about prescription insurance, all pharmacists surveyed agreed that patients lack adequate knowledge about their prescription drug coverage. Pharmacists also expressed an interest in obtaining written information to give to patients with the expectation that it would save them time if patients were more knowledgeable about their prescription insurance. Most pharmacists said that between 50 to 75 percent of patients' pharmacy questions related to prescription insurance. Lastly, according to pharmacists, the most common questions asked by patients pertained to formularies and the cost prior to processing.

In conclusion, there is a discrepancy between patients' perceived knowledge and actual knowledge regarding prescription insurance. Patients are willing to take the time to read a short pamphlet answering questions about prescription insurance but, in general, do not have a desire to learn about any specific topics. Pharmacists currently report spending a great deal of time answering patients' prescription insurance questions. An implication of this study is that providing patients with handouts enhanced their knowledge about prescription insurance. Improving patients' knowledge will allow pharmacists to spend less time dealing with insurance issues and more time on medication counseling. Increasing patient knowledge will also likely allow patients to take a more active role in their healthcare. Hopefully, this should lead to increased medication adherence and better health outcomes.


1. Garnick DW, Hendricks AM, Thorpe KE, Newhouse JP, Donelan K, Blendon RJ. How well do Americans understand their health coverage. Health Affairs 1993; Fall: 204-212

2. Marquis MS. Consumers' knowledge about their health care coverage. Health Care Financing Review 1983; 5(1): 65-80

3. Robertson LM, Middleman AB. Knowledge of health insurance coverage by adolescents and young adults attending a hospital-based clinic. Journal of Adolescent Health 1998; 22: 439-445

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