Prescription Plan Assessment Form
Prescription Plan Assessment Form
How would you describe your current prescription plan?
*
Very Satisfactory
Satisfactory
Neutral
Unsatisfactory
Very Unsatisfactory
Other
How easy is it to understand your prescription plan's coverage details?
*
Very Difficult
1
2
3
4
Very Easy
5
1 is Very Difficult, 5 is Very Easy
Please rate your experience with plan communication and support.
*
1
2
3
4
5
Which of the following best describes your prescription plan usage?
*
Frequent (monthly or more)
Occasional (a few times a year)
Rarely
Have you experienced any issues with prescription coverage or claims?
No issues
Occasional delays
Frequent issues
Other
Rate the affordability of your prescription plan.
*
Very Unaffordable
1
2
3
4
Very Affordable
5
1 is Very Unaffordable, 5 is Very Affordable
Please evaluate the following aspects of your prescription plan.
Rows
Coverage Options
Plan Flexibility
Pharmacy Network
Excellent
1
2
3
Good
4
5
6
Average
7
8
9
Poor
10
11
12
Not Applicable
13
14
15
What feature would most improve your prescription plan experience?
Would you recommend your prescription plan to others?
*
Yes
No
Not Sure
Submit Assessment
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