Open Enrollment: Help Your Patients and Protect Your Profits
Every year, Medicare’s Open Enrollment period is October 15 – December 7. The process of enrolling or updating plans can be frustrating for aging patients, resulting in many staying with a plan, even if it isn’t the best option for their healthcare needs. Helping patients navigate this process is an excellent opportunity for independent pharmacies to act as a healthcare resource for their community. Providing high-touch, personalized service improves retention and increases the probability of the patient enrolling in a mutually beneficial plan, one that saves them money and doesn’t hurt your pharmacy’s bottom line.
Differentiate by Delivering Exceptional Care
The truth in our industry is that business growth can only come from great patient care. Launching a program around Open Enrollment doesn’t have to be intimidating. Start by identifying two important groups of patients in your dispensing data, those who are eligible for the first time to enroll in Medicare and patients who may benefit from an Open Enrollment consultation to select a plan.
Once you’ve identified who would benefit from your expertise, start getting the word out, in your store and in your community.
- Marketing Your Services: Create in-store signs, bag stuffers, and encourage your team to highlight that your pharmacy is offering plan reviews.
- Encourage Referrals: Give cards with contact information to younger patients to share with their parents or older family members.
- Community Outreach: In-person events may not be in the cards for 2021 Open Enrollment, but you can still connect through Zoom or other video chat portals. Reach out to local prescribers and long-term care facilities to support their patient’s needs.
What Pharmacy Owners Need to Know About Open Enrollment
Prioritize Your Efforts in Open Enrollment
Priority #1 – Using your dispensing software or Amplicare Match identify the patients that meet two specific criteria.
- Those currently enrolled in a plan that will NOT be the most affordable for them next year.
AND
- The most affordable plan next year is also the plan that will provide the highest contribution to pharmacy revenue.
If the plan doesn’t decrease the out-of-pocket cost for the patient, we don’t recommend making the switch. The focus for any Open Enrollment period should be around improving outcomes and decreasing co-pays and premiums for your patients.
Priority #2 – Find the patients that simply are not enrolled in the most affordable option.
Conducting plan comparisons builds the relationship with patients and your pharmacy. If you can help your patients understand their options, save them money, and help them switch to a plan that suits their health care need, they are more likely to continue filling prescriptions with your pharmacy.
PRO-TIP: Create a PDF that highlights how much you patient stands to save on their prescriptions per month. Always try to quantify the value you provide when possible.
Priority #3 – Identify Low Income Subsidy (LIS) Network Patients.
An often-overlooked segment of patients is those currently enrolled in or eligible for the Low Income Subsidy Network (LIS). There are four groups of people who may benefit from a consultation or assistance submitting the application for the LIS coverage.
The premium and co-pays for are often the same or comparable across these benchmark plans; allowing you to help them choose a plan that offers better reimbursements and lower DIR fees for your region. Additionally, helping patients who qualify, but aren’t currently enrolled can help in driving referral traffic. You and your team can connect with low-income clinics highlighting this service for vulnerable patients.
Identify Which Plans…
- Have restrictions in place
- Pharmacists and patients should know which plans cover ALL their drugs, require prior authorization, or step therapy for certain drugs.
- Have formulary changes
- Ensure you know the cost of a patient’s plan based on upcoming changes. This can help you find medication alternatives for patients that may not want to switch plans but their medication coverage has changed.
Start Connecting with Patients Early and Often
Some Medicare plans begin communicating with patients about their options before they turn 65, to shift their business to a chain or mail-order pharmacy. Reaching out to eligible patients before they are steered away from your pharmacy is critical.
Additionally, many Medicare members are eligible for an annual MTM review with a pharmacist. Reaching out for an MTM prior to open enrollment helps keep the patient and pharmacist informed, as well as identify opportunities to highlight ways to save your patient money during the open enrollment period.
Want More Information?
PDS teamed up with Enliven Health to help pharmacy owners discover Open Enrollment Tactics that they can implement NOW to protect (and increase) their profits in the coming year. Stay tuned for more information about our upcoming webinar.
