For many Medicare patients, Open Enrollment is the only time they can make changes to their Medicare plans. Whether a patient is newly eligible or shopping for a new plan, they have less than 60 days to enroll in a plan or make changes that will affect their health care for the coming year. And most patients out there aren’t exactly jumping at the opportunity to do so.
Nearly half (47%) of Medicare patients and over half (57%) of patients nearing eligibility are overwhelmed by the prospect of finding the right plan. And, after taking a look at Medicare.gov, it’s no wonder. It’s difficult to navigate. It requires a lot of manual data entry. It can take hours to complete. And beyond all that, the idea of choosing a plan that you can’t change for another year can be daunting. What if there was a better option that the patient simply didn’t understand? What if they made a mistake somewhere in the process?
As a pharmacist, you cannot choose a Medicare plan for your patients. However, you can help them compare plans and guide them through the enrollment process, helping them find the plan that most benefits them. Considering the number of Medicare patients likely coming to your pharmacy — and the number of people you can help — it’s a wise investment of your time.
But plan comparisons don’t just benefit your patients; they can also benefit your pharmacy. Let’s look at how Medicare plan comparisons can lead to win-wins for both your patients and your business:
Plan Comparisons Can Lead to Lower Patient Out-of-Pocket Costs
Many Medicare patients — as many as 94 percent of beneficiaries — aren’t on the most cost-effective plan for their medication regimen. Some are overwhelmed by the selection process and simply choose the top plan. Many existing patients get comfortable with their current plan and see no reason to change, so they don’t even look. But nearly 19 out of every 20 Medicare patients are paying more than they need to for their health care. That’s astronomical.
Medicare.gov allows users to manually enter their medications in order to better drill down plan costs for individuals. We’ll say that again — manually. For every medication a patient is taking, they will need to enter the drug’s name, dosage, quantity, and frequency. We suppose they’re just supposed to line up all the bottles and boxes and go through them one by one.
As their pharmacist, you can help. When you use a plan comparison tool that integrates with your pharmacy software, you already have all that information. And you can compare Medicare plans with them right there at the counter (or even over the phone if the tool has a patient-facing component like FDS Amplicare’s Navigate). You can help your patients easily find the Medicare plan that delivers the best value based on the drugs they’re already taking.
You can also help them find the plans that keep their doctors and specialists in their network. This is particularly true for patients with Medicare Advantage plans, which have more limited doctor networks. FDS Amplicare Match’s Formulary Lookup and Doctor Lookup tools can give you everything you need to ensure your patient’s plan is optimized for both their medications and their doctors.
Plan Comparisons Can Boost Customer Retention & Lower DIR Fees
But plan comparison can benefit your pharmacy, as well. DIR fees have long been a bane of the pharmacy industry. But plan comparison can help through a process FDS Amplicare calls, “DIR Mitigation by Migration.” Here’s how it works:
Certain plans have rebate incentives in place for DIR fees collected from the pharmacy. These plans need to be weighted at the store level, not at the PSAO level. You can identify patients who are habitually non-adherent and on one of these plans. If the patient’s cheapest plan option the next enrollment period doesn’t have adherence as a metric, or if it’s weighed at the PSAO level, it’s recommended that the patient switch to that plan. It also works the other way. If patients are adherent and on a plan that doesn’t reward the pharmacy for good adherence, it’s time to switch.
Beyond DIR fees, offering plan comparisons to your patients has been proven to boost customer loyalty and retention. Patients are 30% more likely to stay with a pharmacy that offers Medicare plan comparison.
Medicare Open Enrollment is a time many patients — and even some pharmacists — often dread because of how complicated the whole procedure can be. It might be easy to tell your patients to simply go to the government website and enroll there. But there are reasons — and good ones, at that — to help navigate your patients through the process.
