Pharmacy Benefits Assessment Form
Please complete this assessment to help us understand your experience and satisfaction with your current pharmacy benefits.
How would you rate your overall satisfaction with your pharmacy benefits?
*
1
2
3
4
5
How easy is it to access your pharmacy benefits information?
*
Very Difficult
1
2
3
4
Very Easy
5
1 is Very Difficult, 5 is Very Easy
How clear and understandable is the information provided about your pharmacy benefits?
*
Not Clear
1
2
3
4
Extremely Clear
5
1 is Not Clear, 5 is Extremely Clear
How likely are you to recommend your pharmacy benefits to others?
*
Not Likely
1
2
3
4
Extremely Likely
5
1 is Not Likely, 5 is Extremely Likely
Which aspect of your pharmacy benefits do you find most valuable?
*
Low out-of-pocket costs
Wide pharmacy network
Prescription drug coverage
Convenient mail-order options
Other
How satisfied are you with the range of medications covered by your benefits?
*
Not Satisfied
1
2
3
4
Very Satisfied
5
1 is Not Satisfied, 5 is Very Satisfied
Please indicate your agreement with the following statements about your pharmacy benefits.
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I find it easy to get prescriptions filled.
1
2
3
4
5
Customer service is helpful and responsive.
6
7
8
9
10
The benefits meet my medication needs.
11
12
13
14
15
Have you experienced any challenges using your pharmacy benefits?
*
No, everything works well
Yes, occasionally
Yes, frequently
What improvements would you like to see in your pharmacy benefits?
Any additional comments or feedback?
Submit Assessment
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