AIS’s Rx Benefit Data: Detailed Data and Insight on Medical and Prescription Drug Benefit Designs

Standardizes benefit offerings and plan designs of commercial health plans — on or off exchanges — in a comparative database

Rx Plan Data at Your Fingertips

Easy-to-use, robust database lets you quickly look up copays and coinsurance amounts for all Rx formulary tiers, and link directly to formularies for individual commercial plans by state.

Now Includes New Medical Benefit Data Fields

Compare copays, coinsurance, deductibles and out-of-pocket limits for in-network providers — primary care physician (PCP) visits, specialist physician visits, emergency room (ER) visits, inpatient facility admissions

Your Subscription Includes:

  • Full access to the online database, news feed and In-App downloads for up to five (5) users — assigned by you.
  • Access to archived data sets for trend analyses — 2014, 2015 and 2016 plan data now available — 29,000+ records!
  • News Feed — Original articles by AIS reporters on trends and challenges in benefit design for consumer marketplaces. Coverage of actuarial issues, formulary placement and exclusions, narrow networks, copay incentives, out-of-pocket costs, consumer response, exchange participation decisions and impact on pharmacy benefit stakeholders.
  • Access to In-App Downloads — Spreadsheets, reports and analyses prepared exclusively for RxB users. Targeted data and insightful perspectives on pharmacy benefit design innovations and strategies are presented in a continually updated selection of downloadable documents.
  • Support from AIS experts on how to thoroughly understand and apply the data to your projects.
  • Commentary from AIS reporters in the field — What we're learning from our sources in health plans, pharmaceutical manufacturers, PBMs, benefit design consultants, consumer advocates and government officials.

Popular Use Cases:

  • Health plans designing pharmacy benefits for their individual and small business customers can discover the available offerings on public exchanges and look for opportunities to distinguish their own exchange products.

  • Pharmaceutical manufacturers can gauge how their prescription products appear on formularies, and can determine where out-of-pocket costs and benefit limits create barriers for consumers.

  • Vendors selling services to health plans can arm themselves with detailed inside information on plan designs and pharmacy benefit offerings in each market.

  • Insurers that already offer products on public exchanges can evaluate their competition and look for expansion opportunities.

  • Brokers can help clients (individuals/families, employers/employees) understand their medical and drug benefits, compare health plan options and shop for coverage.

  • Companies can develop benchmarks to determine benefit trends and create projections about which areas are likely to grow based on plan coverage.

  • Employers can decide if they need to modify their coverage or introduce new models based on the most current benefit design trends from national market research.

  • Analysts can calculate average deductibles, out-of-pocket limits and copays/coinsurances to discover trends by geographic area.

  • Market researchers can make plan-by-plan, tier-by-tier comparisons of coverage and benefits options offered on an exchange.

  • Users of AIS's Directory of Health Plans can link both databases and perform analyses to discover the exchange plan names and Rx benefit offerings of the insurers they'’re tracking.

  • Subscribers of Health Insurance Exchange Database can link both databases to determine the premium rates associated with specific plan design parameters, for a full picture of consumer out-of-pocket costs.

  • Consumer advocates and providers can track out-of-pocket cost burdens associated with specific plans, insurers and exchanges.

Curated for:

  • Health plan benefit designers and market researchers
  • Pharmaceutical marketing professionals
  • Sales and marketing managers at PBMs and SPPs
  • Formulary P&T committies
  • Health plan sales and marketing executives
  • Pharmacy benefit designers, advisors and consultants
  • Small group employers
  • Health care and pharma policymakers
  • Provider network administrators
  • Human resources professionals
  • Value assessment professionals at PBMs
  • Market analysts and market researchers
  • Actuaries
  • Pharmacy stakeholders
  • Insurance agents and brokers
  • Media and academic researchers

Sources include:

Summary of Benefits and Coverage (SBC) documents that are legally required to be available for all ACA-compliant qualified health plans (QHPs). AIS researchers obtain these documents from insurers and exchanges, examine them and carefully select the relevant data for each field. Additional research is performed to clarify, complete, supplement and rearrange the information into a comparable data format. View the detailed methodology statement on the Demo.

Try before you buy – View our interactive product demo View Interactive Demo →
$3,000.00 Add to Cart
or Call 1-800-521-4323 for more information