The Medicare Open Enrollment period for 2024 is quickly approaching – this is a critical time for both your patients and your pharmacy. Every year, the enrollment period runs from October 15 to December 7. This leaves very little time before patients need to re-evaluate their insurance. 

Below  is a breakdown of what you need to be aware of when assisting patients with 2024 open enrollments, as well as a few tips on how your pharmacy can prepare for this busy time at the pharmacy. 

Breakdown of Medicare Types and Coverage

Below is a quick summary to help your eligible patients prepare:

Medicare Part A:  Hospital insurance that includes inpatient and overnight hospital care, skilled nursing facility services, nursing home care, hospice care, and home health services.

Medicare Part B: Medical insurance for outpatient services to prevent, diagnose, and treat medical conditions, like doctor’s appointments, tests, immunizations, durable medical equipment (DME), mental health services, and limited prescription drugs.

Medicare Part C: Also known as Medicare Advantage, this is a bundled plan that combines Part A and B and Part D services. Part C also includes add-on services like vision, dental, and hearing.

Medicare Part D: Additional coverage for Medicare Part A and B patients that covers prescription drugs. 

Also, with Part D covering prescription drugs, below are a few key items to let your patients know:

1. Part D contains the drug formulary. If a patient’s medications are not on the formulary they can request an exception, pay out of pocket, or file an appeal. 
2. All Part D plans must include at least two drugs from most drug categories/treatment classes and must cover all drugs available in the following categories:
• HIV/AIDS treatments
• Antidepressants
• Antipsychotic medications
• Anticonvulsive treatments for seizure disorders
• Immunosuppressant drugs
• Anticancer drugs (unless covered by Part B)
3. Part D plans will also cover most vaccines, except for those covered in Part B.
4. Part D plans do exclude some drugs from being covered by law, these include certain drugs to treat weight loss or gain, and OTC medications.

Medicare Part D Changes Coming in 2024

Changes for Patients

• The projected average total monthly premium for Medicare Part D coverage in 2024 is approximately $55.50, which is a nearly 2% decrease from the 2023 premium of $56.49.
• Stable premiums in 2024 are attributed to improvements made through the Inflation Reduction Act, including drug negotiations, accountability for drug manufacturers, and reduced costs for beneficiaries.
• Transparency in premium calculations empowers beneficiaries to make informed decisions during the Annual Enrollment Period.
• Significant changes in Medicare Part D insulin coverage in 2024, including no deductible for insulin products and a maximum monthly cost of $35.
• Transformative changes in the catastrophic coverage phase, with the elimination of the 5% coinsurance requirement and the establishment of a $8,000 out-of-pocket spending threshold.
• Expansion of the Medicare Part D Low Income Subsidy (Extra Help) program to those between 135% and 150% of the federal poverty line, increasing accessibility.

Potential Implications of 2024 Medicare Changes on Pharmacy Teams

• With CMS releasing the projected average total monthly Part D premium, calculated based on plan bids submitted by
• Medicare Part D plan carriers, this provides insight into premium trends, potentially impacting the selection of preferred medications by patients.
• Medicare Part D plans will no longer apply the deductible to insulin products listed on the formulary or adult vaccines recommended by the Advisory Committee on Immunization Practices, potentially affecting the ordering and foreseeable in-stock quantities needed at pharmacies.
• The $35 maximum monthly cost for insulin in the initial coverage phase or coverage gap phase can lead to increased demand for these medications that may require inventory and workflow adjustments.
• Elimination of the 5% coinsurance during the catastrophic coverage phase may reduce the financial burden on patients but could alter the payment dynamics for pharmacies handling high-cost medications.
• Expansion of the Medicare Part D Low Income Subsidy program to a wider income range could result in more patients seeking assistance with their medicare plan comparisons at pharmacies.

Your Pharmacy’s Role During Open Enrollment

Medicare Open Enrollment 2023 isn’t just important for your patients, it directly benefits your pharmacy as well. 

When patients switch Medicare plans, this often results in more affordable prescriptions which helps to increase medication adherence. Patients are more likely to stay with the pharmacy that helped them receive their medications at an affordable rate, and that took the time to compare and contrast the best Medicare plan for them, versus leaving for a competitor.

Provide Education and Guidance

It’s important for independent pharmacies to stay on top of the Medicare enrollment conversation so you are not at risk of losing business.

Keep patients informed of Medicare information by building Open Enrollment information and reminders into your daily or weekly pharmacy content. This includes sharing newsletters, blog posts, news articles, and social media posts that tell patients about their Medicare plan options. Be sure to explain what to expect during the Open Enrollment period. Add informational content to your pharmacy website with a resources page or banner.

Setting up one-on-one appointment-based comparison consultations is also a great way to help your customers choose a plan. Adding Medicare Part D comparison consultations to your list of services will help you take that extra step with your patients. With so many plans to choose from, having expert guidance from their pharmacy helps patients identify better and healthier alternatives.

With consultations being a time commitment for pharmacies (often taking 20-30 minutes per individual appointment) using an appointment-based model (ABM) to schedule your day can help to save time and streamline the pharmacy workflow. Look for ABM-type platforms that offer Medicare comparison consultation services as a preset appointment type to reduce friction and maximize the patient experience. 

A Few Ways to Market your Medicare Comparison Offerings:

• Promote you Medicare consultation services  or share important updates such as deadline reminders leveraging your IVR greetings and on-hold messaging 
• Send secure 2-way messages to your patients about enrollment season with an appointment sign up link
• Hang informational signage around your store
• Print flyers and keep them at your counter or staple them to prescription bags

Digital Pharmacist is committed to helping independent pharmacies succeed. To learn more about how our digital engagement suite can support your pharmacy and patients this Medicare Open Enrollment season, get in touch today.

Sources

– https://www.medicarefaq.com/blog/how-is-medicare-part-d-changing-in-2024/

–https://www.panfoundation.org/everything-you-need-to-know-about-medicare-reforms/