Pharmacists Use Education to Guide Patients Through Medicare Changes and Direct-to-Consumer Products

In January, millions of Medicare beneficiaries experienced a new deductible, higher out-of-pocket costs, and a fresh wave of sticker shock—especially for those who rely on high-priced specialty medications. For years, pharmacists have been the ones delivering the bad news, explaining why a routine refill suddenly costs hundreds or even thousands of dollars, but a new policy shift aims to change that conversation. Eric Lee, PharmD, BCACP, assistant professor of pharmacy practice at Campbell University, discusses this change as well as the newly introduced TrumpRx.

The Medicare Prescription Payment Plan, part of the ongoing effort to redesign Medicare Part D and make drug costs more predictable, allows patients to spread their out-of-pocket expenses over the course of the year rather than paying a large sum up front. Instead of absorbing the full brunt of January costs in a single visit, eligible patients can elect to pay in monthly installments, with Medicare handling the repayment logistics in the background. Pharmacies continue to be reimbursed on the usual claims timeline, meaning they are no longer caught in the middle of patients’ financial distress.

At the same time, another trend is reshaping how patients access expensive brand-name therapies. Trump RX, a government-run directory of direct-to-patient manufacturer programs, connects patients with channels that allow them to receive medications straight from drugmakers, often at a lower cost. These programs typically bypass traditional pharmacies and do not bill insurance, including Medicare and Medicaid, raising new questions about affordability, continuity of care, and patient guidance.

As pharmacists assume more clinical responsibilities, they are also becoming crucial educators—helping patients navigate complex payment options and access pathways that did not exist just a few years ago.

“I'm really excited for the varying state responses to expanding a pharmacist’s scope of practice so we can practice at the top of our license,” Lee said. “Community pharmacy specifically, we're being asked, and we're ready to provide more clinical care.”