Guest post by Jessica Beyer, iMedicare.
One of the most underused weapons in a pharmacy’s arsenal in the struggle for survival is the ability to perform plan comparisons for their patients. It’s a double edged sword that provides financial gains for both patients and pharmacies alike.
80% of all Medicare patients are not on the most beneficial plan for them.
Plan formulary information can change drastically on a yearly basis, making it extremely important for both pharmacy and patient to re-evaluate plan options each Open Enrollment Period. 80% of all Medicare patients are not on the most beneficial plan for them, and on average, patients can save upwards of $1,150 simply by making sure they are enrolled in the best plan based on their specific needs and medications.
The most common time for Medicare patients to change plans is during Open Enrollment, but there are other opportunities to assist your patients in enrolling in better Medicare Part D plans throughout the calendar year.
The differences in reimbursements to pharmacies can be significant.
Patients who are turning 65 have a 6-month window to enroll in a Medicare plan-- 3 months before their 65th birthday, the month of, and 3 months after. In being proactive with saving patients and pharmacies money, it's important to hone in on these patients throughout the year to help them enroll in their best plan option. In addition to patients who are newly eligible for Medicare, Dual Eligible patients are also able to switch plans throughout the year. These are patients on both Medicare and Medicaid, making their cost variance from one plan to the next very low, however, the differences in reimbursements to pharmacies can be significant.
While reducing costs to patients are of primary importance, pharmacy reimbursement and Direct and Indirect Remuneration (DIR) fees change on a yearly-basis as well. DIR fees have grown as a buzzword over the past few years with more and more plans adopting them into their practices. Occasionally these fees are called "network to plan rebates". Essentially, rates are established and then corresponding fees are taken out of pharmacy reimbursements. The fee might be a flat price (such as $3) or a percentage (such as 3% the full cost of each drug). DIR Fees seem hidden, because they are calculated alongside MAC rates. It's important to note that not every plan has DIR Fees. That being said, DIR Fees are most often associated with preferred plans. With the rising impact of DIR fees and diminishing reimbursements, it's important for pharmacies to stay proactive in managing both patient costs, and their bottom-line.
