Medicare Plan Reviews & Pharmacy: The Overlooked Connection

Patients are confused by Medicare Part D and don’t even want to think about switching plans by themselves, hundreds of surveys have reported.

In other news, the sky is blue.

The fact that Medicare Part D can be entirely baffling is not exactly breaking news. You get it – conducting plan reviews is important, and it’s helpful for your patients. These patients are not exactly eager to spend their free time deciphering the medical Da Vinci Code that is the federal Medicare Plan Finder tool. They’re confused? Shocking. Plans change every year? Groundbreaking. This writer is laying the sarcasm on pretty thick? Never.

Alright, all kidding aside, the point is that you understand the importance of plan reviews for your patients. Piles of studies, surveys, focus groups and even your own experiences confirm the information you already know: your patients need help finding Part D plans.

You know that providing plan reviews is an invaluable service for your patients, but it is also an amazing benefit for your pharmacy. Part D plan reviews offer an amazing opportunity to improve your pharmacy’s business results.

The Overlooked Connection

Every pharmacist knows that a pharmacy’s EQuIPP scores are vastly important. These quality metrics can dictate how your pharmacy will conduct business on a daily basis. The same five measures that EQuIPP uses to rate your pharmacy come from the measures CMS uses to rate their plans. Three of the five measures are based on the adherence of your patients who suffer from diabetes, hypertension, or high cholesterol.

So, how do Part D plan reviews tie in? Providing plan reviews can improve your EQuIPP scores (more on that in a moment), which undoubtedly can improve your bottom line. When your EQuIPP scores improve, your pharmacy is considered to be a high-performing pharmacy. When you are a higher-performing pharmacy, you are more likely to be labeled as a “preferred pharmacy” for more Medicare Part D plans, which can also help attract new patients to your location.

How Plan Reviews Affect EQuIPP Scores

As Part D continues to mature, studies suggest that enrollment in Part D can positively impact patient adherence in a variety of ways. Patients enrolled in Medicare Part D are typically more adherent to their medications than they were prior to enrolling. One study found that diabetic patients improved their adherence by 17.9% and hypertensive patients increased their adherence by 13.5% 1!

This means that just by helping your patients enroll you can improve their adherence, and in turn, raise your EQuIPP scores.

Other Reasons for Non-Adherence

Another prominent reason for non-adherence is affordability. Nearly 1 in 10 Americans reported that they do not take their medications as prescribed because they cannot afford to do so. These patients reported that they intentionally skipped doses, took less medications than prescribed, or even delayed filling their prescriptions in an effort to reduce their prescription costs2.

On average, patients who conduct plan reviews with community pharmacists save $1166.463. Despite the significant saving opportunities, many individuals do not conduct these plan reviews because they are reluctant to revisit the process alone, and they are unaware that their current plan may not still be the most economical option for them in the new year.

So when you provide plan reviews, there are a few positive actions happening:

  • First, you are providing a great service to your patients by helping them navigate and understand the labyrinth that is Medicare Part D.
  • Second, you are improving your patient’s adherence. The data PROVES that patients enrolled in Part D are more likely to be adherent to their medication. What does that mean for you? Improved EQuIPP scores!
  • Third, you are helping your patients to save money AND locate the most affordable option available to them, so they are less likely to become non-adherent due to affordability issues. This also helps you improve your EQuIPP scores.

There is no disputing that providing Part D plan reviews is essential for your patients. Throw a rock and it will likely land on an article telling you everything you already know about how confusing Medicare can be. But don’t forget that this is an equally beneficial opportunity for your pharmacy. Capitalize on this chance to engage with your patients, help them select a valuable plan, and improve your business standings in the process.

1. Zhang, Y., PhD. (2010, May). The Impact of Medicare Part D on Medication Adherence Among … : Medical Care. Retrieved October 10, 2017, from http://journals.lww.com/lww-medicalcare/Abstract/2010/05000/The_Impact_of_Medicare_Part_D_on_Medication.4.aspx
2. Cohen, R. A., PhD, & Villarroel, M. A., PhD. (2015, January). Strategies Used by Adults to Reduce Their Prescription Drug Costs: United States, 2013. Retrieved October 10, 2017, from https://www.cdc.gov/nchs/data/databriefs/db184.pdf
3. Leonard, C. E., Cohenour, F. V., DeLoach, L. A., & Galdo, J. A. (2016, March 5). Impact of an open enrollment service on costs for Medicare Part D beneficiaries. Retrieved October 10, 2017, from http://www.japha.org/article/S1544-3191(17)30135-8/fulltext



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