Here at PDS, we have many incredible solutions partners that have the ability to revolutionize pharmacies through their products and services. We’re so excited to share with you one of them — iMedicare. They would like to share with you the blog they wrote below about how you can join the revolution to reshape Medicare Part D. Read on!
Like PDS, iMedicare shares the same dedication and passion to helping community pharmacies win. Recently, we conducted a survey that polled 5,000+ of our pharmacy customers and discovered that many want to see real change in the industry. A change that serves the independent community, while being patient-focused. So we decided to investigate how pharmacies like you could create a profitable Medicare Part D plan.
Curious? We hoped you’d be! The following will be a thorough step-by-step plan on how to get started building your profitable Medicare Part D plan and help patients along the way:
Step 1: Start an insurance company.
All Medicare plans must have a license from the Department of Insurance (DOI) of the state they want to do business in. Each state has different requirements, the most important one being the capital and surplus requirement.Capital and surplus refers to cash in the bank (assets minus liabilities) and some states require as much as $10 million, as in the case of Iowa.Find each state’s capital requirements from the NAIC (National Association of Insurance Commissioners) here.
So what do you do? You start the new insurance company in North Carolina, which has a $1.1 million capital requirement, then fill out all the forms and get a Certificate of Authority for Insurance. Next, you apply toNAICto get a risk-bearing entity code. Now, you can apply in other states as an out-of-state insurance company to get the Certificate of Authority for each state. Note: you will still need to fulfill the capital requirements for each state. So,you will need around $10 million to ensure all state requirements are satisfied.
Why would you want to apply in every state? Because more states equals more Medicare patients, and more premiums. Having a large number of patients on your plan is key to Medicare plan financials.
But here’s the real reason: Around 400,000 LIS (low income subsidy) patients lose their coverage due to plan and premium changes every year. These low income patients are auto-assigned into one of the LIS-eligible Medicare Part D plans offering a $0 premium for LIS patients. There are 6 LIS-eligible plans in each state, on average. So, if you have a LIS-eligible Part D plan, you will capture 400,000 / 6 = 66,000 new patients in your plans without doing anything – simply due to the way the system works. Let me say this again:
If you have a plan with a premium below the benchmark in all 50 states, you will automatically get 66,000 Medicare patients on your plan each year.
But before you get too excited, you must start a Part D plan and go through the Center of Medicare and Medicaid (CMS) application process. There’s an important CMS rule to be aware of: In the2014 Final CMS Rule, CMS introduced the requirement thatall new Medicare plans must have 2 years of experience in health insurance OR 5 years of experience as a PBM for health insurance.
This CMS rule makes it much harder for new plans to enter the market. You have 2 choices:
- Run your new health insurance company for 2 years before applying to CMS.
(i.e., offer Medicare Supplement plans)
- Buy a failing insurance company with 2 years of experience.
Based on our research, the buying route seems to be the preferred method for many companies.
- Ascension Health (a hospital system) bought a small Health Insurer in February of 2015 for $50 million.Click here for press release.
- Symphonix, now a national Medicare Part D plan, acquired Vista Health for around the same amount.Click here for details of the deal.
The most cost-effective option is to buy aninsurance shell company. These companies go for about $80,000 per state license (that’s about $4 million for 50 states). This does not include the capital and surplus, soyou are looking at a minimum investment of $14 million. The risk with these transactions is the unknown liabilities they bring from previous insurance policies they may have used in the past. While there are some preventive measures to minimize this, trust is a big factor in these transactions.
Step 2: Hire a Pharmacy Benefit Manager (PBM)
While the health insurance company has the licenses, the name, marketing, and contract with CMS, the day-to-day operations of a Part D plan are done by a pharmacy benefit manager.
PBMs do the work behind the scenes. PBMs create and administer the plan formularies, pharmacy networks, rebates, reimbursements, enrollments, phone calls, prescription claims processing, reporting to CMS, and compliance.
You may be tempted to start your own PBM, but it is unlikely that you can comply with all the CMS requirements your first few years.Others have tried, and failed:
By freezing all new enrollments, CMS can put any plan out of business with a stroke of a pen.
To hire a large PBM for all the functions above, you will likely have to pay a signup credit of a few hundred thousand, and then $10-$15 per member per month (PMPM). Or you can get a smaller PBM for $4-$5 PMPM.
Besides the PBM cost, you will need to spend an additional $550k per year: Actuary ($100k), a lawyer ($100k), CMS consultants ($100k), and a Statuary Accountant required on staff full-time ($250k)
Step 3: Create a business plan for your Part D plan
Every year, Medicare plans place a bid on the premium for their plan. For 2017, the average premium was $35.63/month.Click here for the CMS announcement.
CMS subsidizes the premium with an additional $25.45/month per patient, depending on the health risk score of each patient. Moreover, CMS covers 80% of the costs in the Catastrophic phase through what is called “Federal Reinsurance,” which will be around $70 in 2017, judging from theMillimanandKaiser Family Foundationreports. So, added up,Part D plans will receive over $1,500 per member in 2017.
Then there’s DIR. Direct and Indirect Remuneration (DIR), refers to rebates and fees from manufacturers and pharmacies that the PBM negotiates on the plan’s behalf.From 2012 to 2015, DIR has increased from $10 billion to 23 billionaccording to a recent CMS factsheet.The same study shows that DIRs lower the plan’s liability from $1,077 to $666 per member per year (PMPY).
A Part D Plan’s gross profit is $1,500 – $666 = $834 PMPY. PBMs take at most $180 PMPY. Other G&A expenses such as compliance, IT, rent, employees take another $216 PMPY.So the EBITDA of a Medicare Part D plan comes to around $438 per member per year.
So given the $438 in profit per member per year, what do we need to make this a reality?
- Q: First, how many enrollments do you need to make a Part D plan profitable?
A: Depends on the expenses to win an enrollment. With $0 marketing expenses, 100,000 enrollments would put a plan definitively in the black. By pricing the plan premium below the low income benchmark (as we discussed in the last article), your national Medicare Part D plan will receive ~60,000 enrollments automatically from the low-income patients auto-assigned in a plan each year across all 50 states. However, for a Part D plan to truly win the market, it will need closer to 1 million enrollments.
- Q: How does the competition get enrollments?
A: Some Part D plans price their premium below profitability in order to beat the competition. Other plans use insurance brokers to drive enrollments. The commission for these enrollments are around $28 per patient per year for a Part D plan, and ~$400 for a Medicare Advantage plan.
- Q: How can a start-up plan beat the competition?
A: One of the best ways is by partnering with pharmacies.
A start-up plan can partner with pharmacies in each community to drive down patient costs. By lowering patient costs, the Medicare Plan would surpass any other plan’s profitability, and have a key stakeholder in each community.
- Q: Why would pharmacies partner with a Part D Plan?
A: Because pharmacies would have ownership in the Medicare Plan entity.
Hence, the best way for a new Medicare Plan to succeed is if pharmacies themselves own the majority of the new entity.
To make this collective plan a reality, pledge below.
The moment $50 million in pledges is reached, iMedicare will help with the plan setup, to help make pharmacies a real player in the insurance market.
Let’s take a look at your pharmacy marketing.
Are you implementing the foundations of marketing to drive traffic through your door? If you’re like most independent pharmacy owners, you don’t have a fancy marketing team for implementation. In fact, most pharmacies have limited time, money or resources for marketing. That is where most owners give up and focus solely on clinical solutions (which is a mistake, ask me why here or in the comments below!). But since you’re reading this blog, you’re not like most owners, are you?
The need for a dedicated marketing team is a myth. Sure, it’s nice, but you already have the right people on your team, you just have to put the process in place. Now that you know you have the manpower, how do you get access to the right processes and profit strategies?
PDS members have unique access to our member training courses, one of which is Marketing 360. This is a live class taught by PDS pharmacy marketing and business experts, Dr. Lisa Faast (me) and Lisa Baker. We both have an extensive background in marketing specifically for the independent pharmacy industry.
This course shows indepenedent pharmacies how to:
- Build the right team within your pharmacy
- Create anactionable strategy
- Focus on target audiences
- Leverage marketing tools that will optimize your existing efforts
- Infuse the marketing angle on all the PDS profit strategies
- Eliminate the trail and error of developing a marketing plan for your pharmacy.
PDS members who take this course start driving traffic to their pharmacy — fast.
Not a PDS member? Don’t worry, not everyone can be perfect! But you can chat with us about joining if you want to see the same incredible results in your pharmacy. (Just in case you’re wondering… we’re not making this stuff up.)
Watch the video below as Dr. Lisa Faast, PDS’ resident pharmacy expert and VP of Marketing, shows you how to easily get started on your dream marketing plan.
Now is the time to start establishing the supporting tactics for the 2017 strategies you’re implementing. We know that you have limited time, money or resources for marketing. So use yours more efficiently by becoming laser-focused on your marketing efforts.
The next session of Marketing 360 begins on March 30, 2017 in Ft. Lauderdale, Florida. Here’s how you can attend:
Approximately 20,000 independent pharmacies are operating in the U.S. today, and all are facing fierce competition ready to knock them out of the game. The resources and budgets of independents can’t compare to those of a multi-million dollar retail pharmacy, so independents have to get ‘creative’ by harnessing the talents and providing professional development, for everyone on their team.
A new wave of indie pharmacy owners are working to dispel the notion that they are a dated and dying breed of healthcare providers. Here are a few reasons why your local store is the place to visit for your healthcare needs.
- Indie Pioneer: Hashim Zaibak, owner of Hayat Pharmacy, saw the opportunity to save their patients money by providing a low-cost epinephrine pen alternative. This safe and comparable option to an expensive life-saving medication helped uninsured patients when retail giants could not.
- Indie Pioneer: Patient Synchronization (SyncRx) isn’t a new program to the pharmacy industry, but Jason Turner of Moundsville Pharmacy recognized how valuable it could be to patients with complex medication regimens. He developed a Medication Therapy Management (MTM) component which allowed his team to provide OTC solutions for patients suffering medication side effects. Jason changed the game by providing personalized patient solutions.
Your community pharmacy is your local health care destination. No one has the knowledge and latitute to address community health care needs like your local pharmacy. Many have community-centered programs that are beneficial to anyone such as wellness clinics, immunization programs, and disease testing and education.
The end all, be all goal of independent pharmacies is successful patient outcomes.
Your Roadmap is Waiting
When you attend our Super-Conference, you’ll notice that one of our beloved traditions is to recognize the PDS members who have shaken the ground in their success in the last year. These are pharmacy owners who, in one short year, have claimed their success over a variety of struggles. Be it cashflow issues, cultural deficits, financial decline, stagnation — you name it, these owners have come out on top.
Have you ever wondered how successful pharmacy owners have managed to bet against the house and win? Well, we have your roadmap, and it’s easier that you think! You just have to come and sit at the table.
Hundreds of your peers can attest to the success they’ve achieved. We have proof in what your peers are saying and in hard numbers. This is the real deal and we have a guarantee to back it.
If you want to learn more about the PDS Super-Conference, watch the video below as our very own Nicolette Mathey, PharmD and Pharmacy Expert shows real success from real pharmacists… and how their success is your gain!
Watch the video below!
The PDS Super-Conference is the pharmacy event of the year that is guaranteed to change the way you run your business. Join us for the next event in February! Click below for details.
What if we told you it’s possible to thrive during this holiday bustle?
This year’s busy retail season is crazier than ever, and you may be wondering how you will survive Christmas 2018. We know firsthand that major shifts in customer volume and stock shortages are hard to predict. Nevertheless, we want to assist you in taking care of the things that you can control. And, to help you eliminate stress and make sure your operations run smoothly, we created a simple list of practical tips that will help prepare your pharmacy to thrive through the New Year.
- Make sure your shelves are properly stocked, so customers who come in to purchase specific items don’t have to wait in the long lines just to ask if you have more. On the flip side, avoid packing shelves with too much merchandise: displaying fewer items creates the sense of urgency and motivates customers to buy while supplies last.
- Place products strategically throughout the store to maximize sales. Get creative – prepare a speedy recovery kit: tissue paper, hand sanitizer and cold medicine – and display it next to the checkout line or in the areas where customers are waiting on their prescriptions. This will help sell individual items faster, and your patients will know that you care. Eager to introduce new items or promote existing merchandise? Display them next to your holiday best sellers for more visibility and they won’t go unnoticed.
- Organize your selling floor and supply areas so additional merchandise is readily available for quick restocking, especially during rush hours and after store closing. The last thing you want to do is to spend time trying to hunt down a specific product, especially while your customer is waiting.
- Consider extending holiday hours these last few days of 2018. Everyone is busy and your time-crunched customers will appreciate the convenience of having an extra hour of uninterrupted shopping. There should be nothing more important than serving your customers.
- Evaluate last year’s holiday sales to plan and effectively organize staff. Reports that are available in your POS system may provide insight on customer count for a specific time frame, allowing you to quickly identify peak retail shopping hours and schedule more employees for when you need them. Slack times may also be leveraged with preassigned projects: for example, frontline employees who normally run cash registers can help organize shelves and clean the floor during less busy hours.
- Prepare your staff. For some of your employees, this may be their first retail season. Working through holiday hassle and bustle can be overwhelming, so make sure your team understands the responsibilities and has all available resources to effectively prioritize and complete tasks.
- Use sales games as positive reinforcement to reward your staff when they practice higher level selling skills. For example, if the average items per sale in your store is 2.27 items, you should reward them for higher results – like selling 4 or more items to a single customer or achieving a daily average of 3 items per sale or more. To hit those goals, they will have to try harder at adding-on with every customer. The key to making games work for your employees is to make them fun!
We hope that our holiday tips will help you bring down stress levels, boost morale and spread cheer and joy among your team members and patients!
Interested in getting more proven actionable strategies to fuel your business growth?
If you are looking for ways to get more buy-ins and more “yeses” from prescribers, patients, and employees, you need to attend the PDS Super-Conference. We want you to join us and learn how you can use these strategies to start maximizing your potential as soon as possible - and we’re positive that this pharmacy conference will do that for you.
100% sure, in fact – if after the first day, you don’t feel like the conference was worth your time or money? We’ll give you that money back. Not only that, but we’ll give you $300 back on top of your ticket refund for your travel expenses. That’s guaranteed.
We’re expecting over 2,000 guests this year – but if you want to be a part of this incredible opportunity, join now. Click the banner below to find more information and to register.
Millennials, defined as those born between the early 1980’s and 2000, are an extremely brand-loyal generation. Developing relationships with this demographic should be a major goal for your pharmacy. One of the best ways to gain the business of this 80-million member group is to gain their trust. You will be well on your way to securing millennial supporters if you adhere to these six easy tips:
Maintain an Authoritative Online Presence
Their ability to find information about you and your products is crucial. If you offer a service at your pharmacy, like a medication synchronization program, put it on your website and publicize it. Millennials did not learn computers and internet skills later in life like older generations – internet access is all they have ever known. They are the first generation to grow up in a digital world and simply will not trust a business without a quality website and reasonable social media engagement.
Engage with Them
It’s not enough to just have a website and social media accounts. They want to engage with brands on social networks. 62% of millennials say that if a brand interacts with them on social networks, they are more likely to become a loyal customer. This obviously requires more labor on your part, but will be well worth it when your business expands as a result.
Don’t Ignore Their Complaints
Some sociologists refer to the millennials as an entitled generation. What this means for your pharmacy is that ignoring their feelings is a sure way to lose their business. When problems develop, do not avoid them, make excuses or place blame. You should immediately fix the issue. In a millennial’s eyes, the customer is always right and keeping them happy is your responsibility.
Never Misrepresent a Product or Service
Remember, this is the group of people most likely to engage with their peer group over social media. Never misrepresent the features, advantages and benefits of a product or promise anything you can’t deliver. One millennial who feels they have been lied to can easily alert hundreds or even thousands of others within seconds, which will cause big problems for you. On the other hand, millennials can serve as irreplaceable ambassadors if they are happy with your business.
Let Them Help You Plan
Millennial customers are the future, so why not let them help plan that future? When determining upcoming services or goals, let a group of millennials help you decide on the next big steps. In a Forbes survey, 42% said they are interested in helping companies develop future products and services. Typically, companies create products and hope that their target market will consume them. Millennials don’t like this traditional mindset – they want to be involved with products from the beginning of development. If your pharmacy enables them to be part of your brainstorming, the whole process will be more successful.
Donate or Volunteer Locally
Millennials want to stay loyal to a brand that gives back to society. In the same Forbes survey, 75% said that it’s at least somewhat important that a company gives back instead of just making a profit. Millennials love brands that support their local communities and would rather purchase from them than corporate competitors. Your pharmacy can do this easily by rolling out a free children’s vitamin program or other services to benefit underprivileged youth.
If you want to build trust and credibility with your Millennial customers and hold on to them for life, you can easily get started today by watching our free webinar, 5 Ways to Attract, Engage, & Delight Millennials.
“Success comes in cans, not in cannots.” as PDS 2017 keynote speaker Joel Weldon is known for saying. The pharmacy myth that you cannot improve patient outcomes while increasing profits is a dangerous and false self-limiting prophecy; though it is understandable why some would believe it. Driving profits while simultaneously adhering to the best interest of the patient seems too good to be true.
Whether you are focusing on patient outcomes, sales, customer service, or leadership, it all comes down to the relationship you build with your patients that determines the success of your efforts. At PDS2017 Joel Weldon’s presentation “Elephants Don’t Bite! Little Things Make the Difference” will address how your team can take small actions to make a big difference in patient outcomes. PDS has identified 3 ways you can start taking action today. Read on to find out.
Every profit opportunity you implement should directly tie into the goal of better patient outcomes; this is the undercurrent of each strategy Pharmacy Development Services (PDS) provides our members, time and again. Some of our most profitable programs such as our SyncRx+ training rely solely on improving patient outcomes through engagement. The dedicated practice of routine comprehensive medication reviews and medication management pays in the currency of increased patient wellness, understanding, and compliance along with the growth of your bottom line.
PDS offers an array of member programs that produce pharmacy profits and address the patient’s best interest. You need only look at programs such as Bedside Delivery, Clinical Services Profit Ignitor, and Diabetes Care Club. Our point is that sacrificing profits for better patient outcomes is a myth that is dangerous to the pharmacy owner who believes it.
Now that this myth has been debunked, what is the process to ensure a constant focus on improved wellness and profits?
The short answer is, your pharmacy team. The slightly longer answer is, by focusing on the little things you and your team do every day. This leads us to something we’re very fond of saying at PDS:
It’s all the little things done exactly right that separates the ordinary stores from the extraordinary ones.
Your patients’ wellness starts the moment they walk into your store. Creating a culture where your team is knowledgeable of medications, drug interactions, and store products, will expand your patient wellness significantly.
Here are 3 ‘little things’ your team can do to focus on better patient outcomes while ensuring pharmacy profits:
- Provide ‘upsolutions’ to customers that walk through the door.
For example, a team member can suggest solutions such as probiotics to offset antibiotics, or supplements for nutrient depletion — all to ensure patients receive the best therapeutic outcome from their prescriptions.
- Train your pharmacy team regularly.
Providing your team with the proper knowledge of pharmacy products, basic drug interactions, and common upsolutions will give your store the edge it needs to keep the customers happy and healthy.
- Create meaningful conversations with patients.
Your team is in the position to have impactful and informative conversations with patients. Train them to treat every interaction as an opportunity to ask questions, impart knowledge, and coach your customers toward adherence and improved outcomes.
Want more? At the 2017 PDS All-Star Super-Conference, one of our keynote speakers, Joel Weldon, dug deep into how the little things can make the largest difference in your pharmacy, namely on patient wellness and profitability.
Missed the 2017 conference? No problem! You can register now to attend next conference in February!
When you partner with organizations such as Pharmacy Development Services (PDS) and Live Oak Bank, you are choosing to do what it takes to win in an unfair game. You no longer have to make due with whatever prescriptions come through the door. If you know where to look there are countless opportunities to make a substantial profit in your independent pharmacy. Continue reading “Busier or More Profitable: Which Would You Rather Be?”
The Walking Dead (TWD) series has captured the dark imagination of TV audiences over the past six years, and fans (many of whom work at Pharmacy Development Services) are counting down for the season premiere this Sunday. We’ve identified the top three TWD lessons that independent pharmacy owners can apply to running their business.
You may be thinking, “What can a zombie show teach me about running a pharmacy?”
Ok, so you aren’t facing literal life and death decisions in a post-apocalyptic world, but pharmacy owners everywhere are facing significant changes in an industry that is fighting to survive and thrive — just like Rick Grimes and his team. Continue reading “3 Independent Pharmacy Lessons from The Walking Dead”
Data-Analysis for Independent Pharmacy Owners
Are you the type of independent pharmacy owner who is content to drift along with the dated model of taking whatever business happens to walk through the door? Don’t settle for “business as usual” and “my pharmacy is doing just fine.” The unfair game PBM’s are playing won’t change until you start to look at your profitability differently. Discover where big money can be made in independent pharmacy–it’s right under your nose, and you don’t even know it.
Pharmacy Development Services (PDS), believes that the success of each independent pharmacy is a win for everyone and we are ready to show you the level of commitment we have to your success.