Prescription Drug Plan Comparison
Research moved pharmacy access next to cost in the plan results
UX consulting on a member-facing enrollment tool at Prime Therapeutics.
From an insurance card to a plan comparison
A four-step wizard with both signed-in and guest paths, branded separately for each employer group.
Member onboarding & identity
The flow starts from the member’s physical insurance card on purpose. For a pharmacy benefit manager, members need to trust the tool before they share health data.
Pharmacy selection
Pharmacy type matters for compliance, not only as a filter. The inline help and condition-specific callouts were reviewed and agreed on by clinical, legal, and business partners.
Prescription entry
Known prescriptions are filled in automatically, so members do not have to reconstruct their medication history to compare coverage.
Plan review & comparison
The rest of the flow leads to this screen, which compares plans side by side. Members can export it as a PDF to review offline.
Challenge
Prime Therapeutics needed to help health plan members choose prescription drug coverage during open enrollment. Members had different levels of health literacy and strong pharmacy preferences, and most did not know how formulary tiers, prior authorization, or network status would affect their out-of-pocket costs.
Members were trying to do four things: estimate next year’s drug costs, understand what had changed from the previous year, find which plan covers their medications, and find in-network pharmacies that work for them. The tool had to support all four across several employer groups, each with its own plan structures and formularies.
Approach
Embedded on the core team
As Senior UX Consultant on the Prime core team, I directed an external vendor team through prototyping and usability testing.
Structured the tool as a four-step wizard
Health Insurance, Pharmacies, Prescriptions, and Plan Comparison, with signed-in and guest paths and separate branding for each employer group. The main challenge was presenting regulated information, such as formulary tiers, prior authorization flags, and network warnings, in a way members with low health literacy could understand, without hiding anything they needed for the decision.
Tested concepts in each sprint
I ran moderated concept testing in all three sprint cycles.
Outcomes
All participants said they would use the application again, which indicated that the core model worked before the final iteration.
Each finding led to a specific recommendation. Participants did not recognize the plan tabs as clickable, cost figures did not say whether they were for a 30-day or 90-day supply, and coverage amounts were unclear for individual, spouse, and family tiers. The recommendations covered visual hierarchy, prescription-first defaults, and clearer tooltips for tier 3 drugs and prior authorization.
Research showed that the cheapest plan is not always the best one for a member. The results screen was reordered to show in-network pharmacy access and specialty drug flags next to cost.
The guest path was kept as a full experience because research showed that members would leave rather than sign in while they were still exploring options.
Growth opportunity
The tool supported a single enrollment decision. A next step would be to carry the member’s pharmacies, medications, and coverage choices into the following year, so that members do not start over at each enrollment.
Key learning
Members did not choose coverage by calculating costs alone. Many were deciding under time pressure and felt unqualified to decide. The design therefore built confidence first and showed detailed information when members asked for it. Many of the important decisions on this project were about what to leave off a screen, and when to show it.