Part 1: Meeting Patients Where They Are During Medicare Part D Enrollment

October 27, 2020

Tim Jones, director of Managed Care, Elevate Provider Network, dives into the ways that pharmacists can engage with their customers - online and in their store - amid the COVID-19 pandemic during Medicare Part D open enrollment.

Watch more expert interviews from the ThoughtSpot 2020 virtual conference here.

Tim Jones: My name is Tim Jones, I'm director of managed care with the Elevate Provider Network program, which of course is AmerisourceBergen’s PSAO. I've been with AmerisourceBergen for over 20 years, and I've been in the industry even longer than that.

One thing for sure is: every day seems to be a new challenge, but it also brings new opportunities for community pharmacy, so I'm excited to be here today to talk about Medicare Part D.

Community pharmacists play a significant role in supporting patients during Part D, which of course runs October 15 through December 7.

This is such an important time of year for patients 65 and older, because it's an opportunity for them to reevaluate their healthcare needs and determine if their current Part D plan is still the right plan for them.

The problem is, this can be a very difficult and confusing process for many seniors. Community pharmacists have a tremendous opportunity to demonstrate their expertise by assisting these beneficiaries and educating them on their options. This level of support goes a long way in solidifying that patient-pharmacist relationship.

In other words, it's building trust. And this level of trust creates what we call patient stickiness. That's a really great thing to have, particularly when you're constantly battling PBM tactics, such as copay differentials, and patient letter campaigns. The more stickiness you have with the patient, the more likely that patient is going to come and talk to you about their options and the more likely that patient will continue doing business with you as their health care provider of choice.

It's important for pharmacists to engage with their patients during this time, not only to build that patient stickiness that we just talked about, but it's also 1 of the best opportunities to connect with one of your most valuable patient demographics. Medicare Part D often represents between 30-40% of an independent community pharmacy’s patient population. That's a pretty large chunk of business that we need to stay engaged with.

It's really more than just filling prescriptions. Think about the opportunity in terms of vaccinations, medication reviews, med synchronization, and other adherence opportunities. If done correctly, each of these can significantly enhance your pharmacy’s bottom line, it's also a great time to engage in reinforce your participation with Part D.

Many independent pharmacies have found that part D preferred networks are simply unsustainable for their business. At AmerisourceBergen and Good Neighbor Pharmacy (GNP), we believe that patients choose their pharmacy first, and then they choose their plan, not the other way around like the PBMs want us to believe. We believe in the strength of the pharmacist’s relationship with their patient. We've built our standard cost share strategy at Elevate Provider Network on this belief, and it's a strategy that's been very successful for our members.

For 2021, we will see an increase in several attributes of the standard benefit. For example, the deductible will increase from $10 to $445; there'll be an increase of $110 in the initial coverage limit, which will go to $4130.

They'll also be an increase in the out of pocket threshold, which we typically refer to as the TROOP, that increase will be $200 for a total of $6550. And with these increases, the coverage gap, which we've always called the doughnut hole, will basically run from $4130 to $6550.

And then finally, there's catastrophic coverage, where the government picks up the majority of the patient's drug costs, and this will begin at the $6550 mark.

Keep in mind that CMS does allow Part D plans to offer actuarially equivalent variations on the standard benefit, as well as enhanced benefit plans. These variations might be include such attributes as $0 deductible, copayments versus coinsurance, as well as differences in formulary.