4 Ways Pharmacists Can Be Superheroes for Medicare Patients


Medicare patients are the highest users of prescription drugs and a major source of recurring revenue for community pharmacies.

Medicare patients are the highest users of prescription drugs and a major source of recurring revenue for community pharmacies.

Created in 2003, Medicare Part D was designed to help the ever-growing number of Medicare beneficiaries better handle prescription drug costs. Community pharmacists’ accessibility places them in a unique position within the health care ecosystem, as patients are able to ask essentially any health-related question without a prior appointment.

But, with great power comes great responsibility. The following are some ways pharmacists can assist Medicare patients with saving money on their prescriptions and improving their health, all while increasing the overall profitability of their pharmacy:

1. Help patients understand their Part D plans

The average Medicare patient can save more than $1000 a year just by reviewing their plan options annually. Pharmacists have the industry insight to help these patients identify the most cost-effective plans.

There are 3 key things pharmacists should make sure that Medicare patients understand about their Part D plans:

· Plan formularies change each year.

· Many Medicare members are eligible for an annual comprehensive medication review (CMR) with a pharmacist.

· A member’s plan of choice may not be accepted at all pharmacies.

Pharmacists generally refer to the annual CMR as medication therapy management (MTM), but they may want to offer it to patients with easier-to-understand wording. For instance, instead of saying “MTM,” pharmacists may want to refer to it as a “medication check-up.” Pharmacists should explain to eligible members that these appointments are not overly time-consuming and provide an opportunity to address any concerns that patients may have about their medications.

Additionally, pharmacists should remind Medicare members that filling all of their medications at the same pharmacy is not only convenient, but also a safety precaution. Pharmacists are trained to identify drug interactions, so filling at multiple pharmacies doesn’t allow them to see the member’s entire medication history. In addition, not all pharmacies accept all insurance plans, and vice versa.

2. Identify methods for patients to save or manage their money

Pharmacists should make sure Medicare patients understand that deductibles must be met beginning January 1, 2017.

Every year, Medicare patients are surprised that they have to pay a large amount of money out of pocket at the beginning of the year. Therefore, pharmacists should remind members that they will have to meet a deductible again next year.

By helping members choose a plan based on their deductible, pharmacists can help them plan ahead by setting a little extra money aside for that first big prescription medication bill. Some plans have deductibles as low as $100 or as high as $500—amounts that must be met at the beginning of each year before the prescription plan co-pays kick in.

A gentle reminder of this may prevent sticker shock every January.

Additionally, pharmacists can use the annual CMR to focus on identifying potential problems, assessing medication adherence issues, and locating any potential cost savings. Pharmacists may even see an opportunity to help their patients save money on lower-tier medications or preferred products by identifying therapeutic substitutions.

Customizing care for Medicare patients with respect to costs is undeniably burdensome, but there are certain products on the market intended to help save time. For example, many patients walk into a pharmacy expecting to pick up their new prescription, but are then surprised to learn that their drug isn’t covered or requires prior authorization.

iMedicare, a program designed to help pharmacists streamline Medicare patient care, enables pharmacists to use a formulary lookup tool to identify therapeutic alternatives under the patient’s insurance with the respective co-pays and formulary restrictions. These therapeutic alternatives are automatically populated so that pharmacists can exercise their clinical judgment on some suggestions to forward to the patient’s physician for approval. This saves pharmacists a tremendous amount of time and improves the customers’ overall experience.

Pharmacies using iMedicare saved patients an estimated $287 million in 2015 alone, and this cost savings can translate to increased trust between patients and pharmacists.

3. Streamline the open enrollment process

During open enrollment, many seniors looking for a Part D prescription plan to meet their medication needs and budgets turn to their trusted pharmacists to help them make the right decision.

Members have the option to choose a supplemental insurance plan to help cover the cost of their medications. Low-income members may qualify for a subsidized supplemental insurance plan or even subsidized monthly premiums.

Whether patients are changing Part D plans or choosing a plan for the first time, it’s important for them to consider their annual deductible, premium, and co-payments, as well as which plans cover the prescriptions they’re taking, any out-of-pocket expenses, and if their pharmacy is included in the plan.

Pharmacists can remind members to gather their financial information before contacting a Medicare representative in order to determine whether they qualify for financial help.

This year’s open enrollment period for 2017 coverage is October 15, 2016, to December 7, 2016.

4. Make sure your pharmacy is prepared to optimize care for Medicare patients

Even community pharmacies with the best intentions are often ill equipped to adequately address Medicare patients’ inquiries.

“Unfortunately, pharmacists often lack the manpower and time to provide these auxiliary services that can have a substantial impact on their bottom-line,” Matt Johnson, PharmD, founder and COO of iMedicare, explained to Pharmacy Times. “This was the seed of inspiration that grew into a business with the mission to help pharmacists become healthcare superheroes for their patients.”

Fortunately, there are tools available to help community pharmacies looking to care for and retain Medicare beneficiaries.

“iMedicare, is a decision platform designed to integrate with the pharmacy’s workflow. Our flagship product helps pharmacies seamlessly compare Medicare plans for patients within seconds,” Dr. Johnson said. “When integrated with their pharmacy software vendor, they have no need to manually enter any drugs.”

With open enrollment just a few months away, pharmacists may be scrambling to ready their pharmacy for the influx of questions from patients who will come seeking information. To help mitigate the chaos, one iMedicare feature for this upcoming enrollment period will include plan comparisons run in advance for all beneficiaries, so that pharmacists can target their efforts toward interventions that maximize their Medicare patients’ benefits and also improve their pharmacy’s bottom line.

iMedicare also helps pharmacists become more proactive and engage with their patients by using actionable reporting tools to identify the following groups:

· Dual-eligible patients who can change Medicare plans anytime throughout the year and who may not have optimal drug coverage under their current plan

· Patients turning 65 who will soon be eligible to enroll in a plan with a structured method to reach out to them

· Patients affecting the pharmacy’s performance measures set by plan sponsors (eg, those taking high-risk medications)

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