Video: Make the Perfect Match: How to Support Your Medicare AEP Strategy Using Automation | Duration: 4084s | Summary: Make the Perfect Match: How to Support Your Medicare AEP Strategy Using Automation

Transcript for "Make the Perfect Match: How to Support Your Medicare AEP Strategy Using Automation": Welcome to today's webinar hosted by Enlivant Health. Our topic today is make the perfect match, how to support your Medicare AEP strategy using automation. Thanks for joining us today. October is American Pharmacist Month. And before we get started, we wanna acknowledge all the incredible work you all do to keep your communities healthy and happy. Your dedication to your patients and your craft continues to inspire us. We wanted to just say thank you for all that you do. And now on to some housekeeping items. Please type your questions in the q and a tab to ask questions throughout the presentation. We'll be sure to answer your questions during the dedicated q and a session towards the end of our time together. Lastly, we are recording this webinar and will email the recording to all attendees. And now I'm delighted to introduce our speakers. Marvin Guadado has worked with community pharmacies for over 10 years. He started at AmpliCare in 2015 where he held several notable roles. Marvin currently heads Enlivant Health customer enablement team for Medicare match. He ensures customers are set up for success and contributes to the product roadmap by aligning market expectations with product capabilities. Doctor. David Scott received his doctor of pharmacy in 2,007 and his master of business administration in 2010 from the University of Iowa. He worked for an independent pharmacy in Muscatine, Iowa for from 2,007 to 2,010. In 2010, he started working for what is now UnityPoint Health Quad Cities as an informatics pharmacist and was responsible for epic implementation, interfaces, and Pyxis across all 4 hospitals. Scott Pharmacy is an independent community retail pharmacy in Fayette, Iowa that has been in operation since 1979. It was started by doctor Scott's parents who continue to work for the business. Doctor Scott has been working full time at Scott Pharmacy since 2015 and currently serves as operational manager and co owner. Scott Pharmacy currently has 4 pharmacists, 15 technicians, and 10 support staff. They serve Northeast Iowa with mailing and home delivery to £18. They offer long term care services, medication therapy management, medication adherence packaging, and durable medical equipment. Scott Pharmacy is a CPESN USA and CPESN Iowa network pharmacy and serves a large population through outcomes. Scott Pharmacy has been using Medicare match since it was first released in 2013 and uses it each year to help roughly 4,000 Medicare eligible patients with plan comparisons. That's phenomenal. And without further delay, I'll hand it over to you, Marvin. Yeah. Hey. Thanks, Nikki. Thanks so much. Welcome, everyone. I'm excited to to be here. So let's take a quick look at our agenda. So first, as Nikki said, we'll meet our guest, David, owner of Scott Pharmacy in in Iowa, and then we'll quickly dive into an update on the Medicare market and what to expect this AEP. After that, we'll explore how offering plan comparisons and plan reviews is a unique opportunity for pharmacies. Not only with helping patients save money, but also with boosting the pharmacy's bottom line. And that's the the why behind it all. Right? So we'll close out and head into that conversation with David on, getting into the how and hearing how David goes about his his process. So quick look at our mission here at Enliven Health is we we wanna help pharmacies deliver exceptional patient care and do it in a way that drives real sustainable growth. And speaking of sustainable growth, I do wanna go ahead and now introduce our guest, David Scott, again, the owner and pharmacist at Scott's Pharmacy in Iowa. As Nikki said, long time match customer. He's been using it since before I've been here. So very, very instrumental in helping this product get to where it's at today. David, why don't you tell us a bit about your your yourself, your store? Looks like you've been doing plan comparisons for over a decade. How has that opened up more opportunities for your business? Yeah. So, I mean, my bio is pretty complete, but, yeah, we just celebrated 45 years, in business this year for the store. So, mom and dad still work for the store pretty much every day. So, it's nice to get to celebrate 45 years. I mean, there's just so many stores out there you see that have been around for maybe a 100 or more, and just finding it, hard to kinda keep doing what we've been doing, especially when the insurance companies keep changing so so dramatically. But, yeah, I mean, when part d started in 2,005, I mean, at least in Iowa, there's 70 plans, to basically look at, in a PDP space. Not much advantage existed at that time. And and this year where we have 24 plans, just with kind of the overhaul that we will see, with Medicare next year, we're losing about 10 plans. So we'll be down to only about 14 plans, in a PDP space that we'll be able to discuss next year. I think that's both good and bad. We're not maybe loving the plans that are on the bottom dollar, going into next year. We see how those companies have managed, other plans in the past. We still see that there are 2 plans out there that will remain unsanctioned, for for next year that I think helps drive home that point. But we just, will need to continue to be helping patients, look at those plans. Historically, we've always, not really wanted to have the advantage conversations. There's obviously plenty of insurance reps in our area that can assist with that. It's little just a little deeper in the weeds than we've historically wanted to go. But I have 2 technicians that do this full time, during open enrollment. 1 of them did pursue his own insurance license, to be a kind of a broker, this year. So, we wanted to be well positioned to have kinda advantage conversations where we haven't in the past. We had learned very early this year in April, May from our PSAO, that when they look at things like clinical programs and things that are not dispensing related, most of that language has been removed, in the PDP space and may now only exist, under advantage plans that that we'll have access to. So we just wanna make sure we're having those conversations. And, again, with such a widespread, in some of the planned premiums, for next year, I I think a lot of questions will be asked, and potentially an advantage plan may be both a beneficial cost, as well as some additional clinical interventions we can still continue to help people with, without some of these plans paying commissions. We expect a lot of insurance reps will not even help, these patients in some of these plans on the bottom. So we might be a bigger resource this year than we have in in prior years. Yeah. Thanks, David. And great, yeah, great point about the commission aspect of it. Right? Because I follow a bunch of, discussion boards where brokers, you know, independent brokers are ones that's that work for large FMOs. And, because of WellCare, you know, WellCare had that lower premium last year. Then it continue to have one on the value script plan. But last year was paying commission on that. And then this year, it was unprecedented where they said is, you know, the really commissions were because you get that initial commission for signing someone up. And then as they continue on that plan, you get that, renewal revenue as they they stopped paying renewal revenue, as of earlier this year. Right? So a lot, as you said, David, a lot of brokers are saying, you know what? I'm not gonna even service these customers. So they very well could be receiving an ANOC letter that there's a change to their premium, and instead of heading their broker, they're heading to the to the pharmacy. So so yeah. You're right. Absolutely. There's gonna be a lot of brokers that probably don't even have wanna have that conversation and probably signed up a large number of customers to that plan, last year. And, that kinda brings us quickly to, to just an update on this AEP and the Medicare market. Of course, the the enrollment period starts October 15th, 6 days from today, and it runs through December 7th. And for for those of you I know we have a lot of current customers on here and probably some that are looking to sign up here in the next couple of days is that the 2025 data will be loaded into the app on October 15th. In the meantime, based on some initial review of the CMS landscape file, we found and David touched on it, right, where it's going from about 24 PDPs in his market down to 14. Well, the average number of stand alone PDPs, offered per state is decreasing on average from 21 in 2024 to 16. So you see that downward pressure, fewer choices on the PDP side for patients, and that certainly opens up, more of an interest for them going into the the Medicare Advantage Plans. And, you know, I know earlier this summer and there was a lot of concern with premiums on PDPs just spiking significantly and some of them did and we'll get into it in a bit. But, you know, although the premium stabilization program, it helped to keep some of those PDP premiums on check in check, on average, 40% of non dual eligible patients will see an increase on their premium premiums. So that's still gonna be a factor for a lot of folks. And some popular plans are being discontinued, and patients are being crosswalked into more expensive, plans. So so for example, Aetna's SilverScript smart saver PDP, it's it was the second most popular PDP in 2024. It's gonna be contained discontinued nationwide, and all impacted patients will be moved to these Aetna SilverScript choice plan where the monthly premium, you know, went from 18.60 on the original plan to next year 53.60. So that's a $35 increase from what the patient was currently on and for what they're being moved to. So if they do nothing, they will see an increase in premiums. So that's, you know, certainly could be an opportunity for you to talk to those patients there. And we also looked at some of the formularies, you know, and they're looking more restrictive also, especially for those lower cost PDPs. So, again, for example, ransom comparisons on Eliquis found that the $92 UnitedHealth ARP plan, it beats WellCare's $0 plan by about $350 annually for Eliquis. So same with Ozempic, Trulicity, Xarelto, UnitedHealth is even beating WellCare and Repatha, because WellCare is not even covering it. Right? So UnitedHealth, those ARP PDPs, there was 3 this year. It's going down to 2 because the Walgreens PDP is going away. But it's gonna be a big win for people that are on brand name meds. They wanna stick to, PDPs. And, and these 2 ARP plans, you know, historically, have had better reimbursement rates on the brand side than, a lot of these other PDPs. And on the Medicare Advantage side, there's plans. A lot of these plans with no deductible, $47 tier 3 that are just blowing all these low premium PDPs out of the water. So, yeah, David touched on it, but there's gonna be just a lot more interest in these MA plans. And again, there's an opportunity here for pharmacies to help patients, save on premiums, and overall out of pocket cost, all while aligning with plans that are gonna be, financially healthy for the for the pharmacy. So, you know, a bit on the to elaborate a bit more on what David mentioned is on the advantage side, you know, if you're billing to the medical benefit, there's a chance to move more patients to advantage plans, where you build a part b side and there's, the potential to bill for more services, for higher rates, you know, as long as you're credentialed with some of those those payers. So a lot of movement and a lot of shifts this year, this AEP that's gonna impact patients going into next year, and we expect this to continue. It's not gonna be just a one AEP thing. This premium stabilization program, it was a band aid. We very well could be here again next September, next October, expecting these premiums to to go up significantly again. So, wanted to definitely bring everyone up to date on some of the changes we've seen so far. And, you know, David, not sure if you have any comments on that or or what you're doing to prepare for what seems to be a a a different AEP this year than others. Yeah. I mean, we definitely need to get in front of it. Unfortunately, our PSAO with the the one plan that'll obviously scoop a lot of people in, that that contract always seems to be offset for us, and always comes due at the end of February. And so we've always had this impending fear that should a lot of people wind up in there, I mean, a couple months into the year, we could be cut out, really with with no control. They they are frequently now threatening if if the PSAO does not wanna participate in a commercial space, that I guess they then feel that they may withdraw, us, against our will from the Medicare contracting and networking as well. They shouldn't have that power, but they do. So, I mean, you're not gonna really help those people in a in a low premium, plan, because they'll be very, cost conscious, and will not even do kind of the cost plus. Even if we were highly aggressive, I think in a cash pricing standpoint, I mean, it's it's just gonna be hard to convert those, if you don't stay in network to some degree, which again, I think leads back to the advantage conversation this year, just to make people understand that the cost, changes that are out there. Because, I mean, obviously, we'll see some supplemental increases as well. And and just like you said, just a lot of pressure, on patients, as far as what we're seeing for inflation, what they get with social security being fixed limited income, which is why we feel kinda next year, one of the biggest conversations will be around the Medicare, prescription payment program. Any patient we feel that it always come to us at the very first of the month, just blown away by a 600 or $700, co pay because the deductible had not been met, those are the patients we will try and identify and get them enrolled in that, regardless of probably what plan they wind up with, because that's the only way to really smooth that out. And it's in essence kinda leveling off both the plan that has a deductible. The coverage gap in a sense is by definition, I think, kinda being eliminated. And so we're really just looking at making more consistent level payments throughout the year, because that's always a dissatisfier for any patient on a brand and any plan. But especially when we look at next year and we see the tier 6 disappear, with those PDPs, those $11 co pays that were hitting those really high drugs, whether it be the GLPs or or whatever, the that tier 6 is gone. So if they wind up in a tier 3 situation, you only have 2 PDPs in Iowa that are doing that 47 flat. The rest are percentage. Some as high as kinda 25%, which is almost like they're in the coverage gap. So we do need to really look at your brand spend, if you're even gonna participate with brand dispensing next year, and and and be very well versed in explaining why they do not wanna be in a lower monthly premium plan. If there's any brand or even potential for a brand next year. Right. No. Absolutely. And these are things yeah. As a medication patient is adding a medication throughout the year. Right? That's such a great point is that unless they're if they're not a dual eligible, they're stuck on that plan, and there's little they can do. There's maybe some flexibility with a transitional fill, but for the most part, if they're not dual eligible or don't fit into some other special enrollment period exception, they'll they're they're locked in. So certainly great point. If there's a potential for a brand going into next year, then, that's a conversation that, that's a way to get ahead of that because, again, these low cost PDPs, they, they're not the formula is not gonna be the most robust. So thanks for that, David. So let's, quickly, shift shift gears now and talk about how to, operationalize comparisons and streamline the process. So first, David, you know, let's talk about how long it takes you to, perform a plan comparison. Like, what does that process look like for you? So like I said, I have 2 technicians kinda full time, during open enrollment. That's really what it's taken us the last few years to kinda do a couple thousand people in in review, and many others kinda on the fly. But so we we start very early kind of in the August time frame, just building an interest list of people who will want us to do that review or assist that review for them. So we start collecting a list well in advance. And so our list is already kinda 1500 people before we even hit open enrollment period. I'm excited by the fact there'll be less plans, for next year. I think that'll really speed up our review. But we do have an integration with with our software pioneer. I believe most systems integrate, some automatically, some maybe there's a file that you generate and push over, and it might take maybe then 24 hours after that upload to kinda see, all that information depending on how much you're you're throwing in there. But, I mean, in general, with that interface in place, the ability to just pull up a med list and a patient in in the system, fairly readily, I mean, 5 minutes, will it take to kinda look at all the plans? Typically, in the 1st week, they'll get through at least a 100, between the 2 of them as fast as they can. And then we start to kinda just revisit and see what we're seeing for trends, whether it's a big shift in, say, the insulin preference. We had that 1 year that Lantus almost disappeared and went Basaglar. We had the 1 year where Spiriva Handihaler went away, and we had a big shift in cruise. But but trying to notice some of those macro trends that then make the plan, the conversations a little more standard between my 2, technicians. Because I mean, you can always just pick off the rack and and do kinda what is best fit. But if we really dig into the formulary of the plan, look at substitutions that we can make for the patients, then we can usually, tailor it more to them and really make sure they're fitting as best as they can and and not just leave a drug that, oh, well, that one's gonna be uncovered, but there's nothing we can do. Or you can stay on this insulin. The doctor can do a PA, but there's 5 different versions of Lantus, so we can just make sure and keep you on one of them. Because letters are going out, and and they're not very helpful because they'll just say, oh, well, next year your insulin's not covered. I mean, that that's a distressor, and and they those letters shouldn't go out. They're very misleading. They're unhelpful. But, yeah. I mean, we chug through, typically once we have the analysis done. Most of our reach outs are just by phone. We talk about kind of the top three options we're seeing, our recommendation for kind of historically where we've seen that plan go, if that company has been helpful, responsive, if if we need a PA for a drug that they're on, compared to a plan that doesn't need a PA, we kinda explain kinda that risk to them. If they're happy, if they're stable, there's just no guarantee on some of these plans, should they make a change, that that their drugs they're on are are gonna stay, if that's really important to them. We have a very small subset of patients that wanna discuss in person, that kinda keeps our foot traffic a little lower or manageable. It usually comes with either, like, a hearing impairment, or maybe when we have a son or daughter, that's kind of assisting, with an enrollment. Because historically, we haven't been able to do enrollments, just recommend. I'm excited to have an agent in house, Should they choose to engage him on a on a separate kinda side, business through his, setup, he could do that enrollment, but there's obviously certain ways he has to be approached and engaged, so that there's not a full conflict of interest and everything from the insurance side is done correctly. But, yeah, we pretty much do them over the phone. I mean, they'll make 50 calls in a day. Some years, I mean, it was only half of people that might need to move. I mean, next year is just gonna be a big one, unfortunately, where I think 75% of people are gonna need to really consider, where they wanna end up. As far as a plan, as far as the potential for, our ability to still mail to them or deliver to them. We've had some pharmacies close in the area, as has a lot of states. We got clinics closing, access to providers is gonna become more difficult. So we're really becoming the hub of information, whether we want to or not. And so we really need to make sure we're helping navigate, an increasingly complex, system and program that is Medicare Part d. Yeah. Absolutely. And, you know, doing it for 12 plus years. Obviously, you have an ironclad, process in place. And do you and and I think your point about use you know, leveraging your technicians. Right? So we'll have newer customers and, you know, oftentimes they feel like they have to do the whole thing, but, certainly leveraging and delegating this to some individuals at the store technician, anyone who's looking to bring on who take on more responsibility is key. And on on your end, you know, it looks like, you know, your your technician ended up in taking that a step further. Right? Ended up getting licensed and, having further opportunity for to help the pharmacy. Right? Having more of these nuance conversations which, you all were a bit more uncomfortable having previously and also for the individual to have that, additional, revenue stream as as well. So when it comes to, like, before having that that that appointment, right, or in your case, before having that phone appointment. Is there any prep work that you do? Anything that you make sure you're you're looking at, like the current plan, any other things with the doctors, obviously, medications? So we kinda make sure that, obviously, our med list that we got through integration is is correct as far as we know. It it always pulls across those things like antibiotics and and one time things that should be really considered. Sometimes vaccinations are important to plug in there if we know that they'll need those covered in the next year. Other times we remove those. So really just making sure what we know is correct. When we talk to patients, then we find out, oh, well, I'm taking this other medication on the side, or maybe I'm getting this through patient assistance, or or some type of specialty med, that's coming direct from a company. And and sometimes that's important and sometimes it's not. But just making sure we understand, the the drug list is as correct as it can be. We obviously saw that company, I mean, 4 or 5 years ago that after the turn of the year, they increased the cost on about 1100 NDCs. So we're just very wary against these kind of bait and switch scenarios when the plan finders use to show 1 or 2 plans as always the lowest choice. I mean, you can be sure there's gonna be adjustments to that, but then make it potentially not as, the best plan. Whether it's the addition of one drug would would sometimes make a huge huge difference. So we just make sure we, are also looking at people who may express interest, but, they have a retiree benefit. Some people don't understand, because sometimes it may be a PDP from the same company, as a retiree benefit. We had one lady that was approached by an agent in her home or apartment, and even though it was the same company that managed her retirement, got her to sign up for this managed plan. And then it was, it was impossible to then get her back, to what her was her retiree benefit. And so we're always very cautious of that. There's big employer groups, some that have kind of those Medicare equivalent, retiree plans that continue and persist 20 or 30 years after they've left that organization, and so they may get to that point they don't remember, don't understand. I mean, the terminology is just so complex. People still don't know what a complete plan is or a Medicare part c plan or advantage plan. There's just too many terms almost for what we have in the industry, and it's it just causes confusion. Yeah. It's complicated. This stuff is really complicated. You have very educated people that can't make sense of insurance in in general. And when it comes to to Medicare, it's seems to be even a a bit more, complicated. And, you know, to your point where, someone went to a local agent and they were on an employer plan but ended up switching to something else and, you know, those situations are exactly where a pharmacy fits in perfectly into this is you know these patients at a different level. You know them on a personal level, and, you know, you you would know this particular instance with this patient, right, more so than, again, a local broker who is, you know, trying their best, doing their best to help that individual and get them signed up the plans that they're contractor licensed with. But, certainly, when it comes to the pharmacy having that holistic view, really no one else out there in the community knows as much about the patient, as as as you do. And, you know, with our our customers, we ended up creating, like, a 5 step 5 step, pre appointment checklist. One of those is, confirming the patient's current plan. Right? It's good to know where they currently stand to see what their the other options are gonna look at compared to their current plan. And, you know, with our program, we're able to look at our algorithm in PCN, some other data elements to pull in the current plan automatically detecting it about 30 to 30% of the time, 30 to 40% of the time. But we certainly, for those other instances, do recommend pharmacies running e one queries, subsidy checks. And, again, this is perfect where you delegate this to someone else and and just adding that plan into the, Medicare match profile so so that once we know the first the current plan, we it then opens us up to knowing what other opportunities are gonna be better. Like, hey. Is their current plan dropping someone else a drug off their formula that this patient is filling? Is the premium going up? Is there a win win opportunity that's gonna help the patient save money, help the pharmacy drive revenue? It all starts with knowing the patient's current plan. So, certainly, do recommend. That's one of the first things we're doing before that appointment is looking at the patient's current plan. And as David said, also looking at some of these other aspects that, can change going into next year, pulling in medications they might be filling in elsewhere. And, yeah, again, certainly, if they're filling an antibiotic or something that's more of a onetime thing, not including that in the, in the comparison. So let's dive into patient communication. Now you kind of touched on this, a a bit, David, more so on the way you're doing a lot of these comparisons, which is over over the phone. But in terms of, just driving awareness, by this time, everyone knows. I'm sure 12 plus years that you're doing that. But when you were getting this off the ground, what were those methods you were using to drive awareness? You said phone calls. Were you doing anything on handouts, social media? Any other mediums you were using? Yeah. So, I mean, we're pretty old school just considering the the age of of these patients. So everything is just pretty much bag stuffers, and and one of our round of statements, because we got about 2,000, statements that we send every month. We make sure and hit that, which which covers a large chunk. And then the rest, we kinda just do bag stuffers kinda throughout the the duration of the period. We get about 8,000 or so leaflets printed up. They're just a quarter sheet of paper, front and back printed. But it just explains the program, allows them to put their name and and date of birth and and con preferred contact number. We try and flush out those people that tend to winter, or our snowbirds that'll leave, relatively soon. And so we try and prioritize them a little bit if they wanna take care of their, enrollment, before they leave, the state of Iowa. But, yeah, it's, I mean, Facebook just isn't gonna catch kind of that that age, necessarily right now. I mean, in the next 5 years, certainly. We do have a function on our website that they can sign up for the same interest list or wait list, for a review as does the pieces of paper, but, it just it's good for them to have something in hand. I mean, a lot of times, they might have to read it more than once. Maybe they then pin it to the calendar to remember, in the next year or so. We went very old school with it, and that's kinda persisted. There's obviously a lot of of these blue slips in the pharmacy that kinda draw attention near the register and things like that. So whether they walk in, again, we're 75 or 95% delivery in mail. So I mean, that's our connection to them is something physical, something they would see come up come with their order stapled to their receipts. It's just worked best, I think, to do that. But, yeah, as as time goes on, they'll be more accessible, I think, through technology. But but right now, we still haven't seen that be adopted heavily. Yep. And depends on on, yeah, your community, your demograph well, demographics are are the same in terms of the age here, but just how you're currently communicating with your patients. Right? Are you sending brief reminder text messages or letter campaigns? So recommendations, however you're currently communicating with them is, use that same method, that same medium to communicate with them, about this. Or if you wanted to open up a medium, right, if you wanted to get into text messaging your your patients and opening up that line of communication, then, this would be a good way to do that. But, yeah, certainly, knowing your population and communicating with them the way, they wanna be communicated with is key, and it's gonna vary depending on whether someone's, you know, you have a patient base that's more tech savvy or not. But as David said, as we're getting further into, some of these folks that are turning 65 now, 20 years ago, they were, you know, in their early forties, and AOL was very popular. So some of these folks that are aging into Medicare are more and more comfortable with taking some initiative and communicating in, digitally with, with businesses and providers, as well. And, you know, David, in in order to, you know, be more efficient with your time, I know you you you and 2 technicians, I mean, you do a a lot of comparisons, help a lot of patients is, if you could, briefly go into just how how do you go again about prioritizing, the these patients? Like, who do you wanna look at first, and, what does that look like, in terms of, like you said August is when you start communicating with them. So it sounds like in August, it's really start that prioritization as well. Yeah. I mean, I maybe it's just me, but I I try and do kinda first come, first serve. If if they're returning their interest slip, those come with a date. We put that date in. And unless it's like a snowbird situation, we try and handle them in the order they expressed interest. I mean, people get very antsy. This year, they'll probably be even more antsy, just with some of the letters going out and how much some of these premiums are are increasing. But, yeah, I mean, if if you know what plan they're currently on, the first thing you need to do for next year is just know your crosswalk. Know where they're being migrated to. You got some plans that are going from 3 to 1. You have some that might migrate some people down in cost, some up. So just we get a sense. I mean, 2 weeks ago, some of those letters went out. And so those people, for some reason, are already meeting with agents. They're already coming up with plan recommendations for next year, or not even in the enrollment period. So there might be data out there, it sounds, but, it's not gonna be confirmed correct until after the enrollment period even starts. So, we prioritize pretty much on 1st come, 1st serve. Historically, if we had, maybe 5 years ago, we were preferred in a bunch of plans. So then as we started losing, preferred status in a few plans every year, then that would kinda be our priority or focus is to address those patients, because they would certainly get letters that we're leaving preferred status and which pharmacies were then gonna be preferred. Now we find ourselves in kinda preferred and maybe 2 plans out of 14, or 4 plans out of 14. And so if people are are in those, I mean, they might stay. There has been some lowering in some of those plans. So they probably won't be the ones maybe calling, and is urgent about trying to find an option. So we will focus though on on really those those lower premium plans. Just making sure, we're looking at brand, spend and and conflicts in the formulary as far as this year going into next. But yeah. I mean, once we get through our the majority of our list and usually we're trying to wrap that up kinda in in the second to last week in November, then we're kinda more shooting from the hip. We got people walk in or they're calling or they met with an agent. That day, we'll try and, address the call that day and just say, well, we sometimes end up with the same three plans as the agent. But when we use this other program and our pricing is a little more accurate and reliable, maybe the order of those plans comes back differently for us if they come here. They've always used the plan finder to show us as charging, say, $15 on a tier one. That has never ever, ever, ever, ever happened. And so it shows us way off the mark as far as comparing to explain to those patients, before they just decide to up and leave without conversation that that those pricings are not guaranteed correct. And oftentimes, even if we're allowed to collect that, still sometimes the insurance has other limitations or maximum allowable cost, that do not make that correct, but that's how just those plan finders work as far as calculated in annual cost. We might be 600 to $1200 higher. And, frankly, we probably weren't more than 5% different on the year. So, but, yeah, prioritizing just as far as who who gave interest first, is, I guess, what we try and honor, just because we send so many out. But if they get them back to us sooner, we want them to know that they'll be prioritized based on that. 1st come, 1st serve. And, and and, yeah, and certainly in terms of prioritizing, you know, we've been talking to some some some of our customers also that are, you know, of course, looking to to keep their patience. Right? So they're looking at plans that will no longer be accepted. I know, David, you had talked about going from preferred to non preferred. And almost almost everyone is over on the non preferred side. I remember years ago, it was, more skewed in the other direction. It was 1 psa0 that took the initiative to go non preferred on most of these plans, and it seems like a lot of others have followed suit now. But now on top of that, you know, we hear now With psaos in that case being more thoughtful about some of those contracts, but also individual pharmacies, right are being more thoughtful about Just which contracts they sign and staying away from ones that are a bit more punitive if they have that ability to you know directly contract with a particular PBM and, you know, we've heard from a bunch of customers who have opted out of the ESI network, so that's gonna put them out of network for Cigna, for WellCare. Certainly, that's an easy prioritization right there. It's like, hey. I'm not gonna accept these. So, we're gonna have to make sure that we're doing comparisons for them and moving them to to something else. And, you know, on the note of of opting out of ESI is that, you know, the ESI network has one of those WellCare plans which is benchmark, or, in a lot of states across the country. And I think it was Florida last year where, David, you touched on it where there's a sanction plan. Right? ClearSpring was sanctioned last year. That would they had one PDP. They're now coming back with 2 PDPs. I believe their PDP is below 2 stars. I believe the 2 star, unbelievable. So that's what landed them on the sanction list. But in Florida, if I remember correctly, it was Florida that we had customers opted out of esis So they were out of network on well care, which one of their well care plans was benchmark Clear spring was the other if I remember correctly. So like that was sanctioned So there was very limited options in that case if, if we're looking at the number of benchmarks just dropping down so certainly, you know as we're talking to pharmacies and and and pharmacists collectively are getting more comfortable with dealing with new plans that perhaps special needs Are gonna be better fits for somebody's due eligibles if there's not a lot of benchmark options going into next year and, you know, your your some of your staff being more on the agent side moving forward, I think you'll also see beyond AEP going into the beginning of next year. It's, you know, we call this open enrollment in the fall. It's technically called annual enrollment period AEP, but Medicare Advantage open enrollment is that Q1 of the year. So January, February, March, and that is the period of time in which anyone with a Medicare Advantage Plan and switch to another Medicare Advantage Plan. So it's sort of an extended, open enrollment period. And now about half of the market a little bit more than half of the market is on MA. So that could mean that about half your patient population, could be eligible for for, switching plans, during the Q1 of the of the year. So, and and again, even before we said, about smart saver, WellCare, right, some of these premiums that are going up, on WellCare, it really depends on that cheaper premium plan on which state you're in. In New York, the premium is, like, $37, compared to some areas where it's $0. In in, California, it's going up for a little $3 and change to about $17 for the most popular PDP. Right? So, again, in some areas of the country, there's gonna be significant increases on some very popular, PDPs then. And that's an opportunity for you all to to insert yourselves in in that, conversation. And, move moving on here is, you know, David, I know you touched on this to your your appointment, process. I'll need you to get into it, again. But, you know, certainly doing that prior authorization, kinda first come, first served, and starting early. Right? Because agents are starting early also. So I just wanna make sure that if they don't know you're doing this for your community that, that should prompt you to actually get the word out earlier, than than others who have been doing this for years that already have that awareness within the community. And, you know, a lot of our customers are using, again, depending on your community, texting features where they can target and segment patients by several criteria, like, bin PCN, group number, last fill date, age, prescriber. Really could segment that that down very specifically, and just add a link within the text message to an appointment scheduler. Right? So if you're using a scheduling app right now for clinical services, just add a few slots per day for for client comparisons. And, you know, if text messaging method used work for you, then that's a great way to to to get these appointments set up now. So last question for you, David, is, retrospective in nature. It's gonna we do like to reflect, not just project. So, if, this AP was your first time doing client comparison, what would you do differently, now that when you first started? I mean, like you said, there's a lot of pharmacies at this point might be choosing to disenroll with a whole book of business, to kinda make some conversations easier just as far as well, if you wind up on a premium plan where you pay 0, you can imagine how much you're paying us. And and so make it more about community. Because if you just if you just ask them, do you want the cheapest thing possible? And they say, yes. Well, that's a mail order operation. And so then they're basically gonna say, oh, well, I wanna stay more local. Okay. Well, then you need to support local. And if you don't, then you're gonna wind up in these pharmacy deserts that are becoming way more prominent. And then you're talking drives of 30 to 40 minutes to find a pharmacy, maybe up to an hour to find a hospital. And so patients need to understand that, I mean, the the insurance companies are making it easy for them to not support anybody but them. And so I think just really working with your patients and and and hopefully you have rapport, and hopefully they understand the importance of having a local resource, quick acute care things like antibiotics and pain meds, because this macro level is going to make it impossible for us to exist. And then they're going to have a real hard time accessing anything, on a quick basis. I mean, if they're willing to wait a month for their mail order meds to come from another state, 7 states away, I mean, that works fine. Well, it works fine. But other times, there's delays where they can't get the doctors to give refills. And again, with how much prescriber turnover we're seeing, I mean, it might be 4 or 5 days before we, as a local, pharmacy hear back from a local provider. So it's it's just getting very overwhelming, I think, in primary care. And so really just making sure people understand what they're giving up if if they go bottom dollar on on everything across the board. I I would say the thing we haven't done very well in the past is manage the turning 65 list, through your program. But now that I have an agent, I think that's a list we'll stay up on. Because with 10,000 people a day turning 65, it just seems that if we don't intercede in the last year, I mean, they all come in on managed plans. And so if there was potentially something better or something cheaper, if if they were still on 1 or 2 meds and maybe didn't have to make that big of a commitment on day 1, it would have allowed a little more conversation, I feel. So we will be very much doing that list going forward. So that's probably, I guess, what I'd be changing in in the going forward bucket is making sure you catch them early, before they've had other conversations and either get confused or get misled, or or just not understand the connection between the plan they pick, and and their pharmacy basically making or breaking it. Yeah. Great point about nearly eligibles. As you said, 10, 11,000 turning 65 every day, and getting to them early is key. Like, we have some customers who are setting up a birthday call for 64 and starting talking about Medicare at that point. As you said, these folks are coming in already expecting to deal with doctor networks. Right? Already having that sort of plan that kinda we we all have. Right? We have to make sure we go to a doctor that's in network, and that's similar to how it is on the advantage side because that's where, like, a lot of the growth is happening on the MA side because people coming in are signing up for MA. I mean, we're still seeing a good shift of people that are already on Medicare going pdp to MA, but overwhelmingly people that are first signing up for Medicare are looking at those MA plans. So, yeah, certainly, I think, David, we'll have to make sure on your account is that we're set up with those desktop assist notifications because it'll let you know when someone's within that window of newly being newly eligible. And, at the very least, prompt, you know, someone in your staff to have that conversation, print the handout, because those are gonna be, as you said, easier to long I'm sorry, diff more difficult to capture because people are turning their birthdays are throughout the year whereas Medicare, you know, between October 15th December 7th, all Medicare, can switch that to great advice for these folks. Mhmm. Alright. So, before we open it up to the q and a, just wanna remind everyone, if you haven't already, is, just make sure to sign up for the product demo that we're hosting, next week. So we'll walk you through how our product tackles, these medicare changes that we spoke about because, the changes that that have really influenced that we've thought about some of the features that we've built out on the platform. Right? We added a benchmark plan filter. We added a filter to, a tag and a filter that identifies plans that are reimbursing below AWP minus 22% on brands. So, again, we've been very thoughtful with so many things that are happening on the macro level to what we wanna bring into, the software. So, again, we're gonna walk through those changes. Make sure you sign up for that so you can get a live demo on that. And, hopefully, you'll, be ready to sign up with us here ahead of this AEP. And, lastly, I wanna make sure everyone gets a chance to download the ebook. So it stands on some of the topics we talked about here today and how to turn this open enrollment into an opportunity again to guide your patients, the plans that are gonna save the money, and are gonna increase your bottom line. So I will, I'll leave that up here for folks to scan and take it to the chat. So let me well, quite a few here. So, Ashley said you said the Aetna Smart Saver plan is the second most popular. What's the first? Yeah. So so good question. So, yes, Aetna Smart Saver PDP, the one that's being discontinued and people are going over to the choice, that's the 2nd most popular plan. The first is the WellCare value script plans. So that's the one. Again, another one of those is lower cost PDPs, which, Datto's was was expanding on how a lot of these lower cost PDPs may not be a good fit for patients, especially if they're on on brands. And and certainly not a good fit for your pharmacy. Right? Look at those rates on some of those plans. And, I think what we're gonna find here is it's gonna be a wave of patients looking to switch to a better overall plan, better overall fit, not just premium fit that aligns with what's a better, reimbursement for the pharmacy. So thanks for that, Ashley. What do we have here? Kim asked, how do we find which PDPs are still available in our state? So good question, Kim. If you're a customer upon October 15th, we show you all the plans that you're in network with at your pharmacy, and it includes all PDPs within your state if if indeed you are in network, for them. If if you're not working with us, you know, you can certainly go to medicare.gov, type in your ZIP code to your pharmacy, and you can, find out which plans are in network that way. But what we're gonna show in app is only the plans that you're in network with. Right? Because we wanna make sure you're keeping your your patients and you're picking your pharmacy and then their their plan second. Angela asked, what benefits does your program have over doing a review on the Medicare website? So so, Brian, I'm gonna, you know, ask for your so, David, I'm gonna ask for your help on on on on this, for for Angela. You've been using it for for 12 years. What do you see as a difference between the government website and and match? Oh, I mean, the first thing is being able to put all their records in. I mean, that's much faster with an integration or a system where you can kinda upload that information. I mean, I have so many people walking in that just want a hand printed, or report out of our dispensing system for them to take to their agent. The agent's gonna have to put that in. And what if they confuse an ER for an IR? Or what if they put in the wrong version of a tablet? They get a drastically different, price and program that comes up if they miss sometimes a form of a drug. I mean, even tablet capsule, sometimes a large difference. In the last 2 years, we have found medicare.gov to be inaccurate, versus what we understood from our PSAO. And and so it's easier and faster. We we've had, in living health kinda make those corrections to us earlier before Medicare would ever correct if it ever did, just to make sure that everything was was reading out correctly as as far as what their expected cost would be. But just having our own data and being able to put it in, I think, is the most timely, time saved to that. Again, if if Medicare doesn't take action on these insurance companies for misreporting information when I feel they have a whole year to do it correctly, and then to potentially go 3 weeks through open enrollment, have that data not be correct, then then I've lost all faith, in medicare.gov. If there's no penalties, if there's no, issuing of of letters, on behalf of us to explain that, oh, well, we showed preferred, now we're not. Or some pharmacies last year showed it's completely out of network where they were. So you just really have to watch. But, I mean, this one's been the most responsive program for us. It's the quickest to input or just upload the data we already have. So, I guess those are my feelings on it as far as it's useless. No. Absolutely. That was that was great, Angela. I hope that that was helpful because, you know, what I've seen is medicare.gov is a great free tool, but it's something you're using if you're being reactive. Right? Someone's coming in and saying, like, hey. Can you help me? But if you're looking to establish this as a process at your pharmacy that opens up different areas of opportunity, not just in terms of retention and and growing dispensing, revenue and profitability, again, with aligning better reimbursement plans, but, also, if you think about a lot of the Medicare patients that you're you're working with, they're foundational to a lot of these clinical programs. Right? So it's mostly gonna be your patients that are filling the highest number of medications that most of the time aligns with being medicare patients. And if you look at just some of our numbers last year, with with our customers is that 97% of patients that got a plan comparison continued filling at the pharmacy this year compared to 76% of Medicare patients who did not. So that 21 point differential is huge in terms of, you know, again, not just the dispensing revenue side of things, but that 21% that that you could have lost, like, what does that represent on the OTC side, on the front end, right, on the clinical side of things? So certainly looking at these patients holistically is is is key. And and and, again, having a program that's proactive enough to do that is, certainly very important too. And and I wanna piggyback. Christina had asked something about LTCs, and I think it's related to Angela's question about how we differentiate from med.gov. If you look if you have an LTC pharmacy, a lot of independents are getting into that space, right, for, for just additional reimbursement opportunities. And if you look at your LTC pharmacy and med.gov right now, you're gonna be out of network on just about every plan right now. Right? So, on top of that, for the plans that you are in network for, the price that's showing on there for the patient cost is based on retail contracts. So it's never been configured for LTC. So when you're quoting someone, hey, you're probably not gonna be in network for the plan. But if you are, you're gonna be quoting them something that's lower than what they're actually gonna have to pay because of the way they're displaying pricing based on retail contracts. So, you know, we ended up working with some of our LTC customers to, use their dispensing data and use that as a way to, provide those cost estimates more so than relying on on med.gov. So, so thanks for that question, Christina. It was a bit related to Angela's question about the difference between match and the government website. So I'm gonna get through a couple more questions here. So, rami rami asked, for years I've stayed away from looking at medicare advantage plans when I do plan when I do plan comparison They seem complicated and I didn't feel comfortable with that. What is the best advice you could give me if I decide to include, advantage plans into my comparisons this year? David, I'll throw that out to to you, see if you can help Rami with that one. I mean, that's that's why one of my technicians, I think, pursued, kind of that avenue and and becoming his own independent licensed insurance agent. I I think unless you have that behind you, and that background, and that training, and that legal, protection I mean, he has his own LLC now, for what he does. I mean, I I think you just have to get that in-depth with it to probably have those conversations. Now, the other thing to consider is you could partner, or if you know an agent or a pay an agent in the area is your patient, if they'd be willing to be a resource, for you as far as what you know of your reimbursement and kinda just let them know. And usually, there might be only 6 or 7 of those plans if you at least said, well, these 2 or 3 wouldn't be as beneficial for my patients, my pharmacy, but maybe these 3 are. If they could just be referred to them, kinda knowing where they intend to go fill, might make that conversation a little easier, and it's a way to kinda build that connection in in the community. But but I agree it's complex. I find that sometimes, those clinics or hospitals, might show in network with an advantage plan, and then they might find out that they're not. So I I think it's just one of those things. I mean, you have some providers, I'm sure you all know, that don't even take Medicare anymore. And so you just have to be monitoring that, and what they're seeing for reimbursement, and if the providers are even staying, in those networks. If they travel outside your state, you wanna be very wary against, that as far as if they would have coverage wherever state they go to. If they spend half the year in 1, and the other half in another, what is their resident state, and who's able to provide services for them. So, yeah, it's it is complex, and I and I'm not gonna have that conversation. And unless I was an agent, I probably wouldn't. There are other organizations, I think, that are targeting pharmacies and kinda helping you onboard in that arena relatively quickly. I don't know again if you'd wanna dedicate a pharmacist to it, but if you do have a technician that had that interest, I I think there is a pathway to kinda pursue, having more of those agent and advantage conversations. Yeah. It's a great summary. And and we have basically 3 types of customers. Right? One's like like like you that have gotten into this, done this for years, gotten really familiar with it, and either you or someone at this at the pharmacy had taken a next step to getting licensed and and and, you know, getting their their broker license. We have, others who, you know, I've I've learned that a bit more, didn't go all the way to getting licensed, but feel comfortable with talking to some aspect of MA plans. Then we have some customers who will just do the PDPs and then, again, they'll partner with someone in the community or someone within the pharmacy. Or if not, you know, if there's no partner available, we we ourselves partner with an organization called HP 1. So some of our customers will leverage their licensed agents who are trained to make sure the pharma the patient stays at the pharmacy. And that's that's, you know, the key aspect of that that partnership. And, again, if there's any nuanced questions about medical benefits and doctor networks, that's gonna be the first thing you wanna it's gonna be the main thing you wanna make sure is is covered right is those providers and You know looking at the carrier websites could be helpful also, you know, if there's a relationship with a provider or a doctor then, you know having someone at the pharmacy or the patient themselves confirming That hey, there's interest in these 2 ma plans Are the doctors or providers covered under under that or again leveraging? Hp1 who has those relationships with carriers, and have that that information on the, the network status. So certainly, you have resources, right? Whether it's, locally, if you have some partnerships or through, our relationship, if you're a customer, as well. So last couple of questions. 1st, is the Aetna smart saver plan within the CVS earmarked 2025 d plans? And I don't I maybe you you know this, David, but I I believe these are on the, Aetna network or either the p 3 or the s 3 or something like that. Not the 2025 d network. I mean, at least in Iowa, Caremark doesn't have any plans, this year. Most of it was under Aetna. But I mean, if if you're looking at current events, I can't say much. Maybe very much longer. But I mean, it looks like CVS is considering divesting both Aetna and Caremark, as a potential option, for a breakup or just to part ways with them. And I don't know if it's just all the spotlights on them, but, I mean, we all know they should have never been allowed to buy Caremark in the first place. But but, yeah, they are considering selling off Aetna, but most of the plans, in Iowa are under the Aetna umbrella, which would be the p 3. But we signed that back in February. We're always supposed to, but, it sounds like that won't have existence here in the next year. Yeah. No. That's interesting. Right? There are potential breakups, so we'll see if that's just talk. You know, maybe it's sign that the FTC is onto something, so they're trying to get ahead of it. Or maybe they wanna break up on their own terms and not the FTC's. But interesting. Not something we would have imagined would even be considered, like, a year ago or 2 years ago. Kim says, how do we find out benchmark plans in our state? So if you have the application, they will be tagged benchmark within match. If you're still on, Kim, I wanna call out your state. I'll tell you right now. Mark said, we have always heard about ma plans being no no's. Any thoughts? So I think, we elaborate on that on another question. Right? There's, certainly some nuances to, clarify, but there's opportunity there for pharmacies. On a medical billing side, the fact that patients more and more patients are interested in this means that, know pharmacies do have to get more familiar with it That's just where the market is going. And then also there's otc cards, right? There's some of these plans that offer otc cards that oftentimes patients can come and use them at the pharmacy as sort of like a debit card for some over the counter, items. So Kim is still on. She said Illinois. There's 2 benchmark plans. So Illinois is one of the 10 states in the country that only have 2 benchmark plans. So those options for duals on the PDP side are a bit more limited, but, you know, again, perhaps, special needs plans and those plans that are more catered to this population that are on the advantage side, which tend to be, more flexible in the networks on the SMP side, could be a a better fit for some of your patients who, again, have limited options on the benchmark PDPs. So, so I know we went a little bit over. I think I always do this, so apologize. But I'm gonna go ahead and, wrap things up. Wanna thank everyone for spending an hour with us, and, big shout shout out to you, David, for sharing your time and expertise, and, we hope everyone found today's session helpful. Don't forget to join us next week for the live product demo. And, you know, we'd love to show you how we can help your pharmacy with staying ahead of these major changes going into this AP. So we thank you everyone. Thank you, David, and I hope everyone has a, great rest of your day. Take care. Thank you.