Medicare Open Enrollment Allows Pharmacy Expertise to Stand Out
Beneficiaries Want Guidance to Understand Prescription Plan Options
Every year there are changes in Medicare drug plans, including changes in the drugs and formularies, changes in costs, and more. By helping beneficiaries understand the options available to them and the multiple important factors to consider, pharmacies can not only save people money, but also build loyal customers.
Overwhelmed by choice
Nationally, Medicare beneficiaries can choose among an average of 31 prescription drug plans and 18 Medicare Advantage plans, but the number of available plans varies by market. For example, in Miami beneficiaries may choose from nearly 90 plans.1
A 2014 report by the Kaiser Family Foundation, based on discussions with focus groups in four cities, found:2
- The resources available through Medicare were not very useful for comparing plans. This includes the handbook and website, which seniors found confusing and difficult to use.
- Pharmacists, doctors’ offices, friends and insurance agents were among the key places people consult to choose a plan. These are all trusted resources that beneficiaries rely upon.
- Access to their preferred pharmacist was very important for people in Part D plans. People in Medicare Advantage plans sometimes were also concerned about access to certain specialists or hospitals.
“Overall, people tried to compare plans and really wanted to understand their options, but they didn’t have the tools that they wanted,” Gretchen Jacobson, KFF’s associate director of Medicare policy, said in a webcast about the study’s results.
People expected their costs to increase. If costs decrease, beneficiaries wonder what benefits they are losing. But they will change plans if their costs increase a lot or their plan drops a pharmacy, doctor or hospital they value.
So it is critical for pharmacies to show their value to Medicare beneficiaries. One way to do that is to help them sort through the information and discover the best plans for them. People in the study said they wanted personal help in comparing plans.
Educate, but don’t “steer”
Pharmacies may help customers compare plans but cannot recommend a specific option. “You can certainly advise, you can educate … but what cannot happen is that the pharmacy cannot steer someone toward a particular Medicare plan,” said Jeff Baird, chairman of the Health Care Group at law firm Brown & Fortunato, P.C., which has pharmacy clients across the United States.
So, a pharmacy can show customers websites and other tools and help input information, or even provide a brief guide to choosing a Part D plan. If customers ask what they should look for, the pharmacy staff can discuss common issues such as drug coverage and co-pays, Baird said. But if the customer asks something like, “What plan should I join?” at that point the pharmacy staff member must step back and say, “That’s your call,” Baird explained.
Educate staff members who conduct Medicare consultations about what they can and cannot say. For that reason, Baird said it is a good practice to limit who in your pharmacy conducts those consultations. Another best practice he suggests is to separate medication therapy management discussions, which should focus on clinical needs, from consultations about choosing Part D plans.
CMS Medicare marketing regulations do specifically allow providers to announce new or continuing affiliations with specific plans. So, for example, a pharmacy can list the Part D plans in which it participates on signs and in brochures. A pharmacy also may announce a new affiliation to patients within the first 30 days of the new contract using direct mail, email or a phone call.
Click here for promotional ideas from other pharmacists.
Among the things a pharmacy can’t do is offer anything of value to encourage a beneficiary to enroll in a particular plan because that would violate the marketing regulations, a couple of federal laws and possibly state laws.
An evaluation may show a beneficiary could save money with a plan that requires using a different pharmacy. That doesn’t mean you will lose a customer. “Patients appreciate the honesty, and it’s a relationship builder,” said Tim Wright of Wagner Pharmacies, which uses iMedicare software to compare plans for beneficiaries. (See below for more information on iMedicare.)
iMedicare: Import Patient Data for Fast, Detailed Medicare Comparisons
Instead of manually entering a patient’s prescriptions into the Medicare Plan Finder, pharmacists can use iMedicare, a program that automatically accesses that data from their pharmacy software program. The iMedicare tool works with more than 30 types of pharmacy software to create Medicare comparisons personalized for each patient. If you are a member of a buying group or Health Mart,® check to see if they offer special iMedicare pricing as part of your membership.
“It’s quick, it’s easy, and it’s very user friendly,” said Tim Wright, owner of Wagner Pharmacy in Clinton, Iowa. Pharmacists at three Wagner Pharmacy locations used iMedicare to provide about 40 to 50 Medicare consultations during last year’s open enrollment. Creating a report based on information from your pharmacy software takes less than five minutes.
While the Medicare Plan Finder is designed with beneficiaries in mind, Wright said, iMedicare is geared toward both the patient and the pharmacist. With the web or iPad version, you can see:
- Each plan’s monthly and annual costs, including a graph version.
- Formulary information, including drugs that are not covered or that require prior authorization or step therapies. iMedicare also shows therapeutic alternatives and their costs under a plan.
- Preferred network status of your pharmacy, as well as chain or mail-order pharmacy options. One of Wright’s customers decided not to choose a particular plan that would have delivered by mail a specialty medication that requires refrigeration.
After you show a customer the comparison, you can print a report or allow them to sign up for a plan directly through iMedicare. Because the program is available for iPads, a pharmacy can also take it directly to home-bound customers for consultations.
Plus, with 10,000 patients a day becoming eligible for Medicare nationwide, iMedicare can create a monthly report to show which of your current customers are newly eligible for Medicare.