Since its inception in back in the early 2000’s, Medicare Part D has become firmly entrenched as a fixture in the pharmacy landscape. The U.S population age 65 and over has grown nearly 5 times faster than the total population over the last century and represents nearly 17% of the population.
A vast number of this population is covered by Medicare Part D plans. This represents an even greater percentage of total prescriptions. For example, in most of my pharmacies, Medicare Part D prescriptions represent 25-35% of prescriptions dispesed. This is precisely why pharmacies need to pay more attention to Open Enrollment.
Overall, pharmacy benefit managers (PBMs) have generally failed to appreciably steer patients to “preferred” pharmacies. As it turned out, a patient is more likely to choose a Part D plan that works in THEIR pharmacy than choose a plan that requires them to switch pharmacies. This speaks volumes for the trust that our patients put in us as pharmacy owners.
This also represents an important opportunity for the pharmacy owner: it is more critical then ever before to ensure that your patients — the lifeblood of your business — are enrolled in plans for next year that both benefits the patient and your business. With the anticipated DIR hangover looming, now is the time to act.
To make matters more dire, the coming year’s Part D plans are changing significantly. Premiums are going up as well as patient copays. Patients need to be aware that looking at their plan is even more important than ever before.
What can you do? The Centers for Medicare Services (CMS) has strict rules on pharmacy participation in Open Enrollment, and it is critical these are followed. That being said, there are a lot of things you can do to be sure you maintain your patient base and optimize your exposure to next year’s plans.
- Get the word out. Bag stuffers, signs, social media posts, and word of mouth. Make sure everyone knows that this year it is CRITICAL for Part D participants to review their plans.
- Actively aid your patients in choosing a plan. This can be with your own staff (following the CMS rules) or working closely with an insurance agent.
- Leverage tools to increase your efficiency (or the efficiency of the insurance agents) to provide objective data for patients to use to make optimum decisions. TDS Clinical and Prescribe Wellness both offer these types of tools.
- Actively approach those turning 65 to offer assistance in navigating this new arena.
Be sure your pharmacy continues to Thrive next year. Be proactive and make this Open Enrollment season a success for both you and your patients. If you need help with your plans, our consultants are waiting to help! For more information, visit Innovative Pharmacy Solutions.
