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.
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.
The team at RxSafe, the Grand Event Sponsor at the 2017 PDS All-Star Super Conference, walks into the office every day with one goal in mind: to streamline retail pharmacy workflows and inventory management.
Today we share a pharmacy automation case study featuring RxSafe customer Jana Bennett, owner and pharmacist at Medicine Shoppe 0708, and her path from being understaffed to more efficient without hiring a new technician.
Meet Jana Bennett: RxSafe 1800 Customer
Medicine Shoppe 0708 is a pharmacy in Sherman, Texas that is dedicated to friendly, personalized service. The owner and pharmacist, Jana Bennett, is committed to providing accessible and helpful service to customers. She practices the philosophy of treating all customers like they were family.
The pharmacy processes between 375 and 600 scripts per day and primarily serves customers who are 65 and older.
Her Pharmacy’s Challenge
Prior to installing the RxSafe 1800, Medicine Shoppe 0708 was growing quickly and considering hiring more employees in order to get the work done. However, they knew that hiring new employees can sometimes be a challenge and the amount of time needed to manage those resources, substantial.
They were also concerned about internal and external security. The pharmacy previously had two employees who were stealing controlled substances. They had also been burglarized recently. Additionally, in order to better serve their customers, they saw the need to increase efficiency and reduce any chance of human error related to filling.
Finding a Solution
Medicine Shoppe 0708 purchased the RxSafe 1800 after thoroughly researching the competition.
“The competitors only handle the top 200 medications, but we wanted something that would hold and manage all of our inventory,” says Jana Bennett. “The RxSafe 1800 could handle 80% of our volume and the payment was less than hiring another technician. We thought about automation but didn’t think we could afford it. RxSafe changed our mind.”
- Payroll reduction. Significantly increased the volume of prescriptions processed without increasing employee count. Offers the ability to grow significantly without adding any more payroll. “We’ve been able to grow a lot without increasing payroll. Our payroll was 9 percent before, after installing the RxSafe it’s at 7.3 percent.”
- Internal and external security. Secure storage and tracking of drugs prevents theft and diversion. “RxSafe has saved me a lot of mental anguish knowing that I can look at a drug and identify everyone who’s interacted with it. I can tell you in five minutes who has touched any drug.”
- Increased efficiency and reduced error rate. Increased efficiency by removing bottlenecks, accurately tracking all drugs and eliminating filling errors. “RxSafe has eliminated the frustration of trying to locate a bottle—you always know where every drug is.”
- Inventory management. Reduction in physical inventory time and audit process. Eliminates the need to do audit counts. RxSafe does audit counts and transfers the data to the pharmacy management software system. “We’ve been able to increase our inventory turns. Now our average inventory turn rate is between 13-14, before it was around 11.”
- Workflow. Significant reduction in technician’s walking, searching and returning time. “Our employees are happier because the workflow is smoother, it saves a lot of time with put-away, the workspace isn’t cluttered, it’s the same process every time for every script.”
About Medicine Shoppe (MS0708)
The Medicine Shoppe pharmacy was established in 1968 by a pharmacist whose mission was to bring to his community a pharmacy that was both dedicated to personalized service and managed by the pharmacist. Medicine Shoppe International, Inc. (MSI), a Cardinal Health Company, is still distinguished by its commitment to providing expert, personalized health care. MSI is one of the largest franchisors of independent community pharmacies in the U.S. with over 500 Medicine Shoppe and Medicap Pharmacy locations across the United States, and more than 200 international pharmacies.
Connect with RxSafe!
To learn more about RxSafe and their cutting-edge pharmacy automation technology, go to www.RxSafe.com. Also plan to stop by their booth #100 at the 2017 PDS All-Star Super Conference in February in Orlando, Florida.
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?”
Pharmacy Development Services (PDS) takes pride in an unmatched commitment to helping independent pharmacy owners improve their businesses and become more profitable. In the spirit of bringing the latest innovations and best practices to PDS Members, CEO, Dan Benamoz, recently took his Leadership Team on a field trip to see another world class organization up close — Zappos headquartered in Las Vegas, Nevada. This ground-breaking e-commerce organization is known for many things like disrupting the retail sector by selling shoes online and an unwavering commitment to customer service.
So, what can a company that helps independent pharmacy owners have in common with an e-commerce shoe company?
As it turns out, a great deal.
To improve customer service, increase profits, and drive word of mouth referrals, both Zappos and PDS understand that it is imperative to know who your most profitable customers are. Continue reading “Are All Customers Created Equal?”
Prescriptions may be the number one reason customers come into your pharmacy, and they are definitely one of the biggest revenue sources, but it’s vital for your business to boost non-prescription sales as well. In recent years, the profit margins of prescriptions across the industry have been dropping while margins for non-prescription or front-end products remain consistent and strong. Non-prescription merchandise can be an important source of revenue and maximizing your retail sales might be just as important as selling prescribed medications. Here are seven strategic ways to entice customers to make non-prescription purchases and ultimately boost your pharmacy revenue.
1. Study Market Research
Just because you like a particular product doesn’t mean everyone else does too. Don’t rely on your intuition to figure out the best ways to grow your non-prescription sales. Review data and research to determine which over-the-counter and retail products are hot. A study by Hamacher Resource Group (HRG) found that pharmacists assumed that diabetes products ranked as the fourth most-shopped non-prescription category, but point-of-sale data revealed that diabetes products actually ranked 15th. Also, review your sales figures to see which product categories are most popular with your customers and take steps to make these products easier to locate in your pharmacy.
2. Use Your Pharmacy’s Floor Plan to Your Advantag
The layout of your pharmacy can impact how to most effectively display your retail merchandise to generate more sales. Some areas of your pharmacy probably receive more foot traffic than others. For example, areas next to the prescription counter and aisles leading to the checkout registers tend to be higher in traffic. Rotate products in and out of these areas and at the end-of-aisle displays to determine which items see increased sales in these highly visible locations. Testing different floor areas will give you a good idea about where your pharmacy’s prime real estate is located. Moving merchandise around will also help keep your store fresh and current for your customers.
3. Train Your Team to Cross-Sell and Upsell
Your pharmacy staff is your most important asset. Coach them to both build relationships with customers and make relevant product suggestions. Train your staff to be helpful and ask customers what products they are looking for so they can easily find what they came into your store for. Your team might be able to recommend alternative or complementary products. It can also be helpful to hold weekly team meetings to inform your staff what inventory needs to be moved, marked down or removed.. Perhaps hold a contest and reward staff members that upsell the most products each month. For more information on upselling non-prescription products please read our blog post, 7 Ways to Upsell Your Pharmacy Customers
4. Build Strong Customer Relationships
According to HRG research, consumers who have established good, trusted relationships with their pharmacy are more likely to return compared to visiting stores where they don’t have a personal connection. Your talented team is capable of creating an atmosphere of comfort and trust so be sure to train them to engage with customers and establish personal relationships whenever possible. .Guide your staff to recognize repeat customers and greet them by their first name or ask questions about their families, work or pets. Everyone appreciates a personal touch.
5. Stock Related Products Closely
Knowing how products relate to each other can help your pharmacy increase retail sales. For example, people who are looking for a knee brace may find it helpful to also purchase joint cream or customers with a cold might be looking for a box of tissues. Display related products next to each other, so your customers can easily find what they are looking for. And don’t forget to use your pharmacy floor plan to help you determine how to position related products for maximum sales impact.
6. Be Your Own Secret Shopper
Forget everything you know about your pharmacy and walk through the doors as a secret shopper. Walk the aisles with a fresh eye and ask yourself if things look inviting. Would you continue to shop in this store? If you are hesitant, it may be time for some changes. Updating your decor, brightening the lighting, or adding a fresh coat of paint will go a long way in providing your customers with a pleasant shopping experience.
7. Service That Sizzles
It doesn’t matter if you run a pharmacy or a ditchdigging company, everything begins and ends with customer service. Offering truly exceptional service is one of the best ways you can boost merchandise sales at your pharmacy. Ask the question, “Is there something we could do to improve your shopping experience and if so, what would it be?” This not only shows that you care what they think, but also allows you to get direct feedback to inform your team and implement changes.
A pharmacy is so much more than just a place to fill prescriptions. It’s a place where people can find convenience products, supplements, food, souvenirs and other household items. Knowing the most effective ways to increase sales of these items will pay off with a healthybottom-line for your independent pharmacy.
Looking for more ways to stand out from the crowd? Download our free eBook, 3 Innovative Ways to Compete in the Pharmacy Market
How can your pharmacy stand out? How can you make your place of business somewhere your employees want to come to every day? It’s time to connect the dots and help your independent pharmacy profits grow. It’s time you feel that work-life balance.
To help you get there, here are 3 things every successful pharmacy needs:
You’re a leader, but are you leading? Leadership requires a unique skill of inspiration and making your employees feel safe, secure, and confident about their jobs. Building a relationship of trust is the key. If your employees feel secure, they will want to work hard and go that extra mile to get things done. They won’t be afraid to ask questions and evolve -all while staying loyal to your pharmacy. Your employees are more than a group of people that works for you. You’re on the same team, working toward the same goals – and that requires mutual respect. You don’t want your team to come in and simply put in their time, counting down the hours until the weekend. Creating a culture through your brand will attract the right people and will encourage your employees to share the same dreams and goals. Building a motivated team is half the battle to the top.
The ability to stand out from the crowd is another crucial component of any successful pharmacy. There’s a reason why you started an independent business: you wanted to implement your own vision and bring innovative ideas to life — ideas that will satisfy the existing customer base, at the same time opening new revenue streams. Filling prescriptions is just one way to help patients fulfill their needs. Providing them with a great service and a motivational environment will build a trusting relationship, which in turn, will ensure customer retention. Your happy customers will soon turn into brand evangelists who will gladly promote your business because of how much it means to them.
Finally, making connections within your community is what makes a business skyrocket. You may not have put a lot of emphasis on networking when you were in pharmacy school or even working for a chain pharmacy. Owning an independent pharmacy is all about building strong connections: you don’t have to run through every bump in the road on your own. Getting together with like-minded individuals will help you gain a different perspective, as well as encourage you to create and implement new ideas.
Knowing that you’re not alone is a good feeling to have. Sharing mutual problems, giving and taking advice will help you strengthen your pharmacy’s strategy and vision. You’ll have the advantage of avoiding mistakes other pharmacy owners have already made. You’ll gain help in the areas that are most vulnerabile. Additionally, you’ll learn industry secrets early. In the pharmacy industry it’s not uncommon for a drug price to go up, or for certain insurance carriers to lose coverage of some drugs. By connecting with others in the same field, you can obtain this information first and use it to be proactive with your pharmacy business.
Your goal should be to stay ahead of the game, always. To live, breathe, and evolve, your pharmacy business you will need to lead, innovate and connect. It’s not just about filling prescriptions and counting profits. It’s about forming relationships with other industry leaders to help you learn and grow. It’s about being at the forefront of new ideas and the first in your community to dive into fresh opportunities.
Ultimately, it’s about creating an environment that your team wants to be a part of, where it can thrive and the desire to do the best type of work all the time just for your pharmacy exists. You may have already been in business for a few years, but your strategy doesn’t stop just because new business has officially started.
There you have it! These three tools will help you evolve your pharmacy to its fullest potential and keep you ready for the future.
Ready to take your business one step further?
Take an opportunity to tap into some of the juiciest markets that are guaranteed to boost your independent pharmacy profits. Register for the FREE Webinar: 5 Niches Chain Pharmacies Are Ignoring [That You Can’t Afford to Be] – March 18th, 6:30 PM.