Navigating the Great Medicare Migration: How Pharmacists Can Build Stronger Patient Relationships During the Annual Enrollment Period

Medicare is undergoing one of its most significant changes in decades.

Beneficiaries will face a radically different landscape as they look at plans and determine which is the best fit for them. In a typical year, only around 10% of Medicare beneficiaries switch plans,¹ but new policies heading into 2025 will impact patients on a large scale, so more individuals than ever are expected to need to choose a new plan during this year’s Annual Enrollment Period (AEP). Fortunately, pharmacies can turn this uncertainty into a chance to strengthen patient relationships and become trusted advisors in navigating the evolving Medicare landscape.

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Understanding the Legislative Shift

Part of the 2022 Inflation Reduction Act (IRA) was aimed at lowering health care costs, particularly for prescription drugs within Medicare.

One significant change involves catastrophic coverage under Medicare Part D. Starting in 2025, enrollees will only need to spend $2,000 out-of-pocket on covered drugs before catastrophic coverage kicks in, relieving them of further costs for the rest of the year.² This adjustment offers substantial financial relief for patients with high drug costs.

Additionally, there will be a difference in financial responsibility within the catastrophic coverage phase. Medicare's contribution, previously 80% of drug costs, will be reduced to 20% for brand-name drugs and 40% for generics. Drug manufacturers will take on 20% of the cost for brand-name drugs, while Part D plans will now be responsible for covering 60% of the costs for both brand-name and generic medications.² This places a greater financial burden on Part D plans.

Plan sponsors, now confronted with higher costs due to the upcoming reforms, may respond by tightening their formularies to limit the range of drugs they cover as a way to manage expenses. They might also implement other cost-containment measures, such as increasing prior authorizations or introducing step therapy. Although the IRA caps the base beneficiary premium, individual plan premiums could still rise, placing a heavier financial burden on beneficiaries. In some cases, insurers may even withdraw certain plans from the market altogether,³ reducing the availability of options for patients.

Guiding Patients Through Medicare Changes

Pharmacists are in a unique position to guide their patients through the complexities of finding the right plan during this year’s AEP. Many patients may be unaware of the impact the new rules could have on their coverage and out-of-pocket costs. The complexity of the 2025 adjustments makes it essential for patients to have reliable information and guidance.

Pharmacists can help by utilizing targeted tools and strategies to identify patients who would benefit most from a plan review. For instance, analyzing patient data to pinpoint those on plans with premium increases, those who are affected by formulary changes, or individuals facing plan discontinuations ensures that outreach efforts are focused on those most likely to be impacted.

Effective communication is crucial in spreading awareness about plan comparisons. Automated messaging campaigns, whether through text, email, or mobile apps, can inform patients of the available services. Tailoring these messages to specific patient groups ensures that the information resonates, encouraging more patients to explore their options.

Making the plan comparison process as convenient as possible is also essential. Pharmacies can make it easier for patients to take action by offering online scheduling for consultations, integrating plan reviews into existing appointments, or even providing consultations at local senior centers. Digital solutions can even enable patients to review their options from home, further simplifying the process.

For example, S&S Drug, a longstanding pharmacy in downtown Beloit, Kansas, has made Medicare plan comparisons a cornerstone of their service, helping to distinguish themselves from larger chains. With nearly a quarter of Beloit's population aged 65 and older and 60% of S&S Drug's claims going through Medicare Part D, the pharmacy recognized the importance of providing personalized Medicare guidance. With the help of digital match software, S&S Drug routinely conducts around 1000 plan comparisons during open enrollment, sometimes seeing up to 45 patients a day. This service has not only strengthened patient relationships but has also become a key driver of customer retention and business growth for the pharmacy.⁴

Accurate, data-driven plan comparisons strengthen patient relationships. By pulling specific cost data from pharmacy records and comparing it across available plans, pharmacists can provide clear, actionable advice that helps patients make informed decisions. This level of personalized service not only helps patients find the best coverage but also builds trust and loyalty to the pharmacy.

Beyond AEP

The "Great Medicare Migration" is more than just a seasonal event; it represents a significant evolution in the dynamics of pharmacist-patient relationships. As Medicare beneficiaries navigate an increasingly complex health care landscape, the role of the pharmacist is evolving from a dispenser of medications to a trusted health care advisor. This deeper level of engagement can foster stronger, meaningful relationships that extend far beyond the AEP.

The future of health care is one where pharmacists play a pivotal role, and AEP is the perfect opportunity to prove it.

REFERENCES

1. Biniek JF, Damico A, Cubanski J, Neuman T. Medicare beneficiaries rarely change their coverage during open enrollment. KFF. November 1, 2022. Accessed October 9, 2024. https://www.kff.org/medicare/issue-brief/medicare-beneficiaries-rarely-change-their-coverage-during-open-enrollment/

2. Cubanski J, Neuman T. Changes to Medicare Part D in 2024 and 2025 under the Inflation Reduction Act and how enrollees will benefit. KFF. April 20, 2023. Accessed October 9, 2024. https://www.kff.org/medicare/issue-brief/changes-to-medicare-part-d-in-2024-and-2025-under-the-inflation-reduction-act-and-how-enrollees-will-benefit/

3. Pifer R. Humana and CVS are downsizing their Medicare Advantage plans for 2025. Which insurers could benefit? Healthcare Dive. Updated June 10, 2024. Accessed October 9, 2024. https://www.healthcaredive.com/news/humana-cvs-medicare-advantage-benefit-plan-cuts-2025-unitedhealth/716764/

4. Case Study: S&S Drug. EnlivenHealth. Accessed October 9, 2024. https://enlivenhealth.co/medicare-match-case-study-s-and-s-drug/