Did you know that Medicare part D open enrollment begins Oct 15th? It's a great opportunity to help our patients find better plans if needed. Also, in 2019, some efforts to close the coverage gap or doughnut hole. Below is a cross post from the Pharmacy COI on pharmacists involvement in Medicare Part D Enrollment,in case you have not seen this.
Pharmacists Involvement in Medicare Part D Open Enrollment
Ben Farlow, PharmD Candidate1, Geoffrey Twigg, PharmD, BCACP, CDE2, Tosin David, PharmD1
1 University of Maryland School of Pharmacy; Princess Anne, MD
2 Apple Discount Drugs; Salisbury, MD
Background
During my first semester as a pharmacy student I had the opportunity to work in a large, community pharmacy in a rural area on the Eastern Shore of Maryland. As a student I was eager to see what I was learning in classroom didactic studies put to work in real world patient encounters. I had the opportunity to spend extended periods of time in the diabetes education department and in helping pharmacists perform clinical medication reconciliations as a part of Medicare D open enrollment. I was not prepared for how much these services worked together. While working with the pharmacist CDEs I learned that the typical person with diabetes (PWD) referred into the diabetes center is on 8 chronic medications. As a student often times it is easy to take for granted what you think a patient knows about their medications and underlying medical conditions. It wasn’t until I had the opportunity to work directly with patients from DSME classes that I realized how much of an impact a pharmacist could have on a patient’s life. In this role, I helped PWD understand how their medication regimen and insurance formulary affected their medical expenditures and finances.
Medicare D Open Enrollment
Medicare D Open Enrollment occurs between October 15th and December 7th each year and the new plan goes into effect on January 1st of the following year. During this open enrollment period, patients are free to choose a new plan with no penalties. If a patient chooses to not take advantage of the Medicare Open Enrollment period they are automatically re-enrolled into the same plan as they participated the previous year.
There are numerous tools available to patients and pharmacists to aid in the choice of a Medicare D plan. Medicare.gov has a patient friendly website to help look at prescription drug plan formularies and make selections based on plans offered in the patient’s geographical location. There are more options available to pharmacies such as Amplicare and Prescribe Wellness have their own platforms, often that integrate into the pharmacy’s dispensing software, to aid the pharmacist in helping the patient to understand their options.
In 2019 Medicare D will be undergoing some changes. The biggest of these changes is the continued closing of the Medicare coverage gap, commonly referred to as the donut hole. During the year coverage gap period the patient will only have to pay 25% of total drug charges. Also the patient’s out of pocket expenses, commonly referred to as TrOOP, will increase from $5,000 to $5,100. With the burden of explaining prescription drug benefits often falling on the community pharmacist and staff these changes will represent a unique opportunity for the pharmacist to help educate the patient to help maximize their pharmacy benefits.
For pharmacists that provide DSME services, helping a patient navigate Medicare benefits can be a challenge. With the economic burden that diabetes presents, the pharmacy has the ability to help a patient pick a Medicare Part D Plan that offers the least disruption to their medication regimen. Since diabetes drug classes such as insulin, GLP-1 receptor agonists, SGLT-2 inhibitors, and DPP-4 inhibitors do not have generic options, many times patients are left scrambling to afford their medications once they enter the coverage gap.
Student Pharmacist Perspective
When I entered the pharmacy for my Introductory Pharmacy Practice Experience (IPPE), I was not sure what to expect. I had previous lectures in schools on diabetes, medication therapy management (MTM), and pharmacy economics. I was expecting each day to bring a new experience to help cement what I had learned in class. What I was not expecting was how the pharmacists had to be experts in all these disciplines of pharmacy at the same time and how many of these programs that the pharmacy operated overlapped.
Almost all DSME sessions began with a comprehensive medication review and an assessment of the patient’s health literacy and understanding of their drug therapy. I was shocked to see how many patients had diabetes, often for years or decades, and could not answer basic questions about the condition. I was equally surprised to learn how ‘graduating’ the pharmacy’s DSME class was often the beginning of the need for medication management. The pharmacist CDEs had patients come back almost daily into the pharmacy for a medication checkup. The pharmacists were making recommendations back to prescribers to change medications based on blood glucose meter downloads. I was seeing numerous sulfonylurea agents being discontinued to reduce hypoglycemia as patient’s made healthier food choices. I also had the opportunity to see a number of patients switch from basal-bolus insulin to a basal and a GLP-1. Although, I was saddened to see several patients struggle to get medication changes that may have benefited them due to inadequate prescription drug benefit.
It was an eye opening experience to see this first hand. I was expecting the pharmacist to plug medications into a computer and then tell the patient what the best plan would be based on expected copayments and premiums. Instead, what I saw was the pharmacist identifying therapeutic duplications, dosage errors, and guideline based omissions. I saw countless recommendations that would benefit a patient’s pharmacoeconomic burden. It was rewarding to see patients that I had worked days before in the diabetes center who stated they were struggling to make ends meet due to drug costs suddenly feel empowered when they realized how their healthcare dollars were allocated.
Conclusions
As a student most of my experience has been in the retail, community pharmacy setting. It was not a new concept to me that patients often times do not understand their insurance benefits. There were countless times that patients would be frustrated at the pharmacy counter when they did not understand terms like prior authorization, drug tiers, and coverage gaps. With expensive disease states such as diabetes that often times requires complex medication management, there is pharmacists have a valuable to educate the patient during the open enrollment process.
Important Dates to Consider:
October 15 to December 7 – “Annual Election Period” – Enrollment period for Medicare Part D Plans
January 1 – Benefits from new or existing Medicare Part D Plan will go in place
January 1 to February 14 - Medicare Advantage Disenrollment Period
References:
- https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/when-can-i-join-a-health-or-drug-plan.html#collapse-3190
- https://q1medicare.com/PartD-The-2019-Medicare-Part-D-Outlook.php