Left as-is, current exchange formulary and network search technology has the potential for a lot of consumer dissatisfaction and backlash.
In just under half of the public exchanges, it is "difficult or impossible" for shoppers to figure out which drugs are covered by health plans, researchers at Avalere Health found in a study of 12 state-based and five federally-run exchanges.
In eight exchanges, plan formularies are either difficult to access, such as in Florida and New York, or almost impossible to find, with no online links to the drug lists in California, Massachusetts, Oregon, Rhode Island, Washington and Washington D.C.
In nine of the exchanges studied, formularies are at least moderately accessible, Avalere researchers found in the study, funded by Pfizer.
HealthCare.gov and six state-based HIX websites -- Colorado, Connecticut, Maryland, Minnesota, Nevada and New York -- include links to both formularies and provider directories for each plan. But the links are not always direct, in some cases redirecting to an insurer's homepage and requiring a fair amount of navigation to find the information.
For next year, the federal government is requiring insurers selling plans in the federal exchange to have direct links to formularies, such as an accompanying PDF, and as more state exchanges improve the core technology, they may try to adopt drug search tools, like Nevada's.
On Nevada Health Link, plan shoppers can search for plans by certain drugs or by class of drugs, with the tool showing which plans cover the drugs along with any restrictions and defaulting to generics if they're available.
However, the tool does not include estimates of out-of-pocket costs for drugs and could potentially sow confusion with its nomenclature and displays, argued one of the researchers, Avalere Health vice president Caroline Pearson.
"While the tool includes a legend for the symbols related to drug coverage, there is still a lack of clarity around the difference" of terms such as non-formulary, non-reimbursed, not-listed and preferred and approved.
"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 in a media release.
During open enrollment, there were reports of some consumers struggling to find formulary information to figure out which plans covered medications needed for chronic conditions, and in one high-profile case, the problem came amid the news of plan cancellations and helped fuel a bit of anti-ACA sentiment.
Stephen Blackwood, the president of Ralston College in Georgia, wrote in the Wall Street Journal of his mother's "Sisyphean" ordeal trying to find a plan covering the cancer drug Sandostatin, after her long-time Blue Cross plan was cancelled.
Suffering from a neuroendocrine cancer, Blackwood's mother, a manager at her husband's medical practice in Virginia, talked with a number of insurance enrollment agents before finding a plan that, she was told, would cover the drug, Blackwood wrote.
"Because, however, the enrollment agents did not -- unbelievable though this may seem -- have access to the 'coverage formularies' for the plans they were selling, they said the only way to find out in detail what was in the plan was to buy the plan."
Blackwood's mother bought the plan in November, and then in February was told the drug would not be covered, leaving her potentially exposed to thousands of dollars in monthly costs. Blackwood was left concluding that "ObamaCare made my mother's old plan illegal, and it forced her to buy a new plan that would accelerate her disease and death."
Whatever the reason for the drug not being covered -- the issue is under appeal -- the brokers or enrollment representatives should have had access to the plan formularies, even last fall, during the throes of Healthcare.gov's dysfunction. And, as the Avalere study suggests, consumers should have direct access to the formularies themselves to make the right selections for their needs (and to avoid problems like Blackwood's mother's ordeal).
In another realm of potential consumer backlash -- the caveats to President Obama's "If you like your doctor, you can keep your doctor" promise -- Avalere found that locating provider directories in exchange plans was "somewhat easier" than formularies.
More than 75 percent of plans in the 17 states studied offered at least moderately accessible access to provider network directories, with eight of the state exchanges offering a provider lookup tool. Only Oregon and Washington D.C. had no links to provider directories.