Name: Reclaim Your Revenue: Fighting Low Reimbursement Rates with Medicare Plan Comparisons
Uploaded: 2025-09-24T18:16:55.507Z
Duration: 59 min 48 s
Description: Reclaim Your Revenue: Fighting Low Reimbursement Rates with Medicare Plan Comparisons

Transcript for "Reclaim Your Revenue: Fighting Low Reimbursement Rates with Medicare Plan Comparisons": Welcome to today's webinar hosted by EnlivenHealth. Our topic today is reclaiming your revenue, finding low reimbursement rates with Medicare plan comparisons. This webinar is part of the American Pharmacies beyond the fill series. Thanks for joining us today. Before we get started, I'd like to highlight a few 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 we will email the recording to all attendees. And now I'm delighted to introduce our speakers. Marvin Guardado has worked with community pharmacies for over ten years. He started at AmpliCare in 2015 where he held several notable roles. Arvin currently heads EnlivenHealth solution sales and strategy team for Match. He ensures customers are set up for success and contributes to the product road map by aligning market expectations with product capabilities. Jeff Jacobs has over twenty five years of experience in pharmacy. He brings a wealth of knowledge from working in diverse environments, including his role as a licensed pharmacy technician. Over the past decade, one area of focus has been with the development and implementation of reimbursement analysis and with Rx Compass, American Pharmacies analytics platform and trusted solution for actionable Rx reporting. Jeff also collaborates closely with members to create effective and successful utilization programs designed specifically for pharmacies by pharmacies. With a strong emphasis on support, ROI, efficiency, and sustained growth, Jeff's expertise is centered on helping community practices maximize their potential strategically. Jenna Domzalski de Rios is the pharmacy and owner of Noel Pharmacy. Born and raised in New Mexico, Jenna has deep roots in local community and in the local community, excuse me, and a lifelong connection to the pharmacy world. Growing up in a family owned pharmacy, she developed a passion for health care and customer service from an early age. After earning a doctorate of pharmacy degree from the University of Mexico of New Mexico, Jenna returned to the family business. For the past twelve years, she's owned and operated Noel Pharmacy where she's expanded the pharmacy's services to meet the evolving needs of their customers. Today, the pharmacy offers not only medications, but a wide range of health care solutions, helping improve the overall overall well-being of the community she serves. And without further delay, I'll hand it over to Marvin. Thanks, Nikki, and thanks everyone for, joining us today. And quick look at our agenda. We're gonna start with the partnership between EnlivenHealth and American Pharmacies. This group, as Nikki said, does so much for their members from political advocacy to bringing the right technology and strategies to their pharmacies. Jeff is then gonna walk us through the state of Part d reimbursement. I'll let him be the messenger of those of that news. And, from there, we'll cover the Medicare landscape. What carriers are doing for 2026, how they're responding to margin pressures and the inflation reduction act, and what that means for patients, and, ultimately, your pharmacy. We'll also touch on the continued growth of Medicare Advantage Plans and where pharmacies can find revenue opportunities as that wave continues. And finally, we'll talk with Jenna about why she offers plan comparisons, how she works them into her workflow, and the results she and her staff have seen from their hard work. Before we dive in, I'm gonna touch real quick on our mission, which is to be the innovation epicenter where health and care unite at the pharmacy. And that's why today, we're gonna be talking about Medicare because it's one of the clearest ways your pharmacy can impact the patient's health and financial outcomes, both yours and your patient's financial outcomes. With that, I'll hand it over to Jeff to talk a bit more about American pharmacies and the state of part d reimbursements. Thanks, Marvin. So this is a little bit about American pharmacies, who we are. We're a member owned co op. You know, we're based out of Texas, but we're actually have members across the country in, many states at this point, and our mission is to protect, defend, and enhance the independent pharmacy business model. Now we maintain a culture of servant leadership, and I I can't stress that enough because we're here to serve independent community pharmacy. And, we do that with a very robust willingness to act. We're very eager to stand up and support of an independent pharmacy and to advocate for these community mainstays whenever and wherever that we can. And we do that through our, purchasing economic model, which is unique in the marketplace and unmatched legislative advocacy. And, a great example of that would be our fly in that we did in Washington DC just last week, where we had many of our member pharmacies and and other folks that we work with on the legislative front fly into Washington DC and meet with, over 40 different legislative offices, in that time. And we're also ready to get involved in the courtroom as as necessary. So if you would like more information about us, please do visit our website or, check us out on social media, and be sure to join the next Beyond the Phil webinar, that's coming up soon, next month. Next slide, please. Alright. So the question you may may be asking yourself is how do we get here, or what is truly driving the diminishing margins and performance? Let's back up to January 2024 when several key changes drove significant industry change with Medicare part d. First, the miracle finally happened. DIR fees were eliminated. And while everyone eagerly anticipated the departure of these fees, few were prepared for the impact to their finances. Historically, it was difficult to calculate net reimbursement for Part d plans that included a DIR. Pharmacies could easily see point of sale reimbursement and the DIR separately, but reconciling the two by r x number and fill was a challenge for most. So bullets one and two here are grouped and that one resulted in the other. The revenue coming in was overinflated, then later clawed back in a way that was always delayed, untimely, and difficult to track. This resulted in cash flow concerns for many community pharmacies who were glad that their DRs were taken away, but struggling with that without that upfront revenue that had grown operation operationally accustomed to. Additionally, millions of covered lives moved to ESI at the same time. WellCare and Prime Therapeutics standard network, just a couple of examples, and many didn't initially realize how many of their patients fell into these buckets. Pharmacies were seeing ESI Part d patient volume increase in the three to even five or 600% range. Brand wholesale acquisition cost increased as it does every year, but the real factor driving down profit at point of sale was this new aggressive reimbursement rate. Generic prescriptions weren't the concern, Just brands, especially extended day supply brands, pharmacies who were previously on the fence with diversifying through new non Rx programs began eagerly seeing seeking out these opportunities, which has continued and is expected to persist until at least meaningful legislative support occurs. So let's dive a little bit deeper into the details. Next slide, please. Express Scripts brand rates dropped to AWP minus 25.5 for regular day supply, minus 30.5% for extended day supply. Just to break even with this rate of reimbursement, the dispensing pharmacy would need cost minus 10.6% or minus 11.3% for extended day supply. This brand cost of goods is possible, but value would rot from generics where the bulk of the value lies, which is ultimately unsustainable. Unless you were fortunate enough to be awarded rural rates, the combination of ESI part d and brands is a legitimate threat to community pharmacy business. Add to this the high demand and prevalence of GLP ones, and it's easy to see how this got so challenging for so many so quickly. I think it's reasonable to assume that many pharmacy closures in 2024 and 2025 are a direct result of this specific dynamic. On top of all this, Humana, who historically was the top brand payer, took a similar path to ESI and essentially baked DIRs into their brand rate, just not quite as aggressively. Humana's brand rate of AWP minus 21.7% requires a net cost of approximately minus 6% to break even. So the next time you hear a peer share concerns about their cost of goods, you might ask them if they're aware of the extent of their ESI part d and Humana brand exposure, which could explain everything, including cash flow concerns. Now thank the lord there is hope. Again, generic ESI part d reimbursement is acceptable, and this volume is incredibly important, but can vary by patient, household, and pharmacy. Humana continued their adherence based incentive program, which has the potential to make a significant impact on net payer revenue. However, these dollars take time to arrive, so cash flow could be an issue. It's likely to your benefit to limit or even eliminate ninety day brands for most part d patients. Filling mostly thirty day prescriptions means more touch points per patient annually, which can be unbelievably valuable as each interaction is an inter is an opportunity to showcase more revenue driving services and programs. Extend patient revenue wherever you can. Next slide, please. No matter how you diversify, make sure it's cumulative growth. Adding a variety of proven solutions that drive profitable revenue is the key, but don't replace the initiatives that are working. Add to them. Nutrient depletion is a great way to make positive impact clinically while boosting cash profit. It's patient specific and replaces what some prescription meds deplete and can often bring multiple supplements into the mix for one patient. I recommend sticking with pharmaceutical grade options whenever possible to ensure maximum absorption and importantly, a higher margin. It's a win win. If they're in front of you, put the bottle in the patient's hand while telling them about it. American Pharmacies members are encouraged to consider partner designs for health and will enjoy preferred pricing and free dietary supplement specialist training for pharmacy staff. Maximize those available HSA, FSA, and Medicare Advantage OTC dollars too. Designs for Health has a complimentary virtual dispensary option in which their products aren't stocked physically on your shelves. However, you earn incentive when patients purchase products through this online dispensary, which is specific to your pharmacy. HSA and FSA covers tax and shipping with this virtual option too. Profitable refill adherence is incredibly important to ensure the highest value prescriptions are consistently filled on time. For our members, consider our highly successful guided growth adherence program using your ARC's Compass access. It's free, and your peers working the guided growth program would agree there's likely not a more profitable or efficient alternative out there. In fact, from Apex twenty twenty four to Apex twenty twenty five, one member in Newport Beach, California captured over $1,200,000 in revenue using guided growth. Many pharmacies are pursuing long term care at home, which makes sense because you're likely already serving at least some eligible patients but missing out on the higher rate of reimbursement. Connect with American Pharmacies partner, LTC at Home Pharmacy Network, for a population assessment and don't delay. Get started now. Be sure to let your APRX rep know that you're interested. Whether submitted by you or your PSAO, rebill successful MACA pills within the approved time frame to max out that reimbursement. Pursue MTMs, and if you haven't already, start down the path with medical billing. This is another area where your pharmacy may already be providing enhanced clinical value but not getting paid for it. American pharmacies can provide guidance here, so like with everything else, members aren't starting from zero. There are other ways beyond these to go beyond the fill and extend revenue to combat poor reimbursement. American pharmacies members are encouraged to contact their account rep today to learn more and to get started. And as a segue into our primary discussion today, plan selection during open enrollment periods and when patients turn 65 throughout the year is a key way to facilitate better coverage and affordability. Only a EnlivenHealth's match tool considers the patient then also the pharmacy, which is important to address for reimbursement when it makes sense for the patient. Match is effective and affordable and includes strong support when you need it. And with that, I'll hand it over to you, Marvin. Thanks, Jeff. Excuse me. Appreciate that. And I like the way you broke this all down. Really organized, really easy to understand what that workflow would look like. And and although match is, listed here, you know, monthly seasonal, it really touches a lot of these things that Jeff, mentioned here. Right? Whether it's, profitable refill adherence, nutrient depletion, expanding clinical benefits, long term care at home. Right? Not all PBMs, do recognize long term care at home, so recognizing which ones do and getting patients to those plans are gonna help you drive that, revenue stream as well. So appreciate that, Jeff. And and I'm gonna bring Jenna into the conversation. You know, her store has been using match for over ten years, and last year helped over a 100 patients submit their online enrollment applications through match. And that was primarily driven by identifying those win win plans that help both the patient and the pharmacy. But before we get into the plan comparison piece here, Jeff, I'd love for you to share a bit about the monthly senior center classes that your pharmacy, runs. You cover looks like you cover a wide range of information there. So few questions is, like, how long have you been doing these classes? Who usually runs them? And and what does a typical session look like? Thank you, Marvin. Yes. So, we've been doing these classes for about two years, and we do them once a month at the senior center. We have one here locally in Lovington, another one in Tatum, and so we offer those to the senior center, seniors. And we go in there, we'll offer blood pressure, and then with that, we'll also help with the medications that relate to blood pressure, similar with diabetes. And then we are, offer a one c testing, the blood pressure monitoring cholesterol, and, offering that to them to educate them on how to take care of their health better. And, yes. And then usually, it's myself or my sister that does that. And we just offered it actually yesterday, and we were doing the vaccine clinic for them. Awesome. And how do you how do you get the word out to seniors in the community about these events? Usually, we, have flyers out. They do meals on wheels and, the senior centers are really good about informing their, their customers. But we also do flyers in the pharmacy as well as sometimes social media. Awesome. And have you noticed that those classes are leading to more engagement with your pharmacy outside of these events? Yes. The more contact that we can have with the elderly, it's, it's hard to sometimes build that trust with them, especially with so many things coming and going, so many spam phone calls. It really takes a lot to build a trust with the elderly. And so the more that we have those points of touch, they trust you more, they're willing to come in, and so it has gained, more people coming into the pharmacy, but also being able just to help them as well. Absolutely. Thanks for for sharing that, Jenna. It's a great example of the way you're connecting with patients outside of the four walls at your pharmacy. I know it's often hard to get out of a pharmacy, but, you know, doing so and connecting with community is is is huge. Right? And, so so let's shift gears a bit into the Medicare plan comparison. So, again, you've been doing this to your pharmacy, been offering this service for some time now. What made you decide to start performing plan comparisons at your pharmacy, and how did you first introduce them into your workflow? We started offering them, people with a lot of our customers would come in with questions, and we were trying just to educate ourselves on which plans would be best for them, long term as well as for ourselves reimbursement. And so we just noticed that, getting a head start on this and being proactive helped us and helped our patients as well. And so, we decided to start doing that more often. And so now we even create a list for open enrollment starts that our, customers that are interested in reviewing over their plans will have a list already created as well as creating Excel sheets from EnlivenHealth of plans that, might not be as preferred for our reimbursement and giving those customers a call. And so that's kinda how we work it into our workflow, creating those Excel worksheets, creating a list of people that would like to and then also those, people that are low income or dual eligible are a great opportunity as well. So we make sure to contact them because majority of the time, those customers, they don't think about changing their plans. But their plans also are bad for reimbursement for us. Yeah. And just in a few days, right, the plans are gonna come out here in the next week or week and a half or so. We're gonna see we're talking about dual eligibles, what which benchmark plans are, gonna remain benchmark plans in 2026. Right? And these are the ones that are applicable to, those dual eligible patients you you you mentioned. And, and, also, you made a good point, right, is that you're setting yourself up. I know it's often hard pharmacy owners to really visualize what that ROI is gonna be like. Right? Because you're not seeing it right away as if you, give a vaccination and and build a vaccine. Right? It's something where you're setting yourself up for 2026 on the retention front and, again, optimizing, the reimbursements that you're gonna be seeing in twenty twenty twenty six. So that's a, you know, great lead into where we wanna take the conversation to next. And let's talk about what we're all facing right now. Right? And we've been calling it the the perfect storm. So our broker partner, HP one, they just completed all the first looks, carrier meetings that they have throughout the summer. And in the past, you know, they mentioned how, those meetings were pretty much a sales pitch. Right? Carriers were just laying out their benefits and telling brokers why their plan's gonna be the best one to sell. But this year, everything is different. The tone, the mood, what they're covering. Those conversations were less about growth this summer and more about pulling back. You know, outside of Humana, almost every national carrier is scaling down. So plans are becoming less competitive, and in some cases, carriers are exiting markets altogether. You know, if you look at UnitedHealth alone, they're expected to orphan about 600,000 of their members. Aetna, a 150,000. So you take those two carriers. Right? You're over 700,000 patients just between those two. And then you have regional players like Vermont, Blue Cross, Sonder in Georgia, which fully exited, and you're probably looking at millions of patients that are gonna be displaced and, needing to switch. And, you know, we've heard the phrase a lot from just the carrier space, again, from our broker partner is, musical chairs over and over again these last couple of months. So, again, millions of patients are gonna be scrambling for a new plan because their benefits are gonna be eroded somewhat. And, you know, the way it sounds like carriers are are putting is almost funny. Like, no one wants to be the best plan, but no one wants to be the worst either. It's like I don't know. If you're dating and you're going out on a restaurant, you take a date out to a restaurant, you probably can't splurge on the cheap on the most expensive one, but you don't want the cheapest one either. So you set up for, like, the second or the third cheapest. And and and it looks like, you know, carriers are are doing just that. They're taking the approach of my 20 year old self going to restaurants, and not wanting to be the best, but not, wanting to be the the worst. And, you know, even though we're seeing pullbacks on the advantage side, the PDP side is worse. PDPs are the least profitable Medicare product for carriers, and we're seeing more consolidation there. WellCare and Cigna, they're going from three PDPs down to two. And if that trend continues, you know, we could very well see, where there's only a few PDPs left. I mean, there's a few now where there's even fewer than that. And, you know, for context, WellCare alone controls 43% of the PDP market. And WellCare rolls up to that ESI network that Jeff mentioned. Right? So, if you have a lot of patients, just like the country does on WellCare in terms of PDP, that's almost half of the market on a WellCare PDP. And, you know, again, because of that, these PDPs don't make sense for your pharmacy either. On the reimbursement side, again, on the brand side, really aggressive rates. And, many times as you saw on the previous slide, they're reimbursing well below cost. So pharmacies, they need to keep a close eye on this trend because as that market continues to shift, what's being cons what's consistent this year is that PDPs are just continuing to be deprioritized. So they're steadily on their way out. So with PDPs dwindling go ahead and move on here. The real growth is happening in in special needs plans, and these are a type of Medicare Advantage Plan. They offer richer benefits designed for patients with greater needs, like dual eligibles that Jenna mentioned, or patients with at least one chronic condition. And right now, we have fifty eight percent of Medicare beneficiaries that are enrolled in Medicare Advantage Plans compared to that number was probably below forty percent, I think, around the co around 2020 for COVID. And that number is projected to keep climbing. So that's projected to get up to sixty four percent in the next ten years according to the to the CBO. So the question is, you know, what's the upside for pharmacies in this trend? Right? What's the benefits to riding this wave? And first is clinical services. Right? Many pharmacies are expanding into clinical services and billing to the medical benefit, And some of these customers are billing med sync consults to Medicare Advantage Plans using CPT code 99212. You got carriers like United and Humana that are paying for these in certain states. Pharmacies are seeing about $30 per console each month across dozens of patients. So that's essentially a subscription like revenue that revenue stream that could turn up a patient that was unprofitable to a profitable one. So if you're already credentialed and contracted to bill for, the medical benefit for these services, this is gonna be a clear opportunity for you to capture new revenue and align patients that would be a good fit or you that you're already doing Medsync consoles for into plans that are paying for the service. And another is gonna be OTC benefits. In many MA plans, especially dual special needs plans, they offer OTC cards that patients can redeem at your pharmacy. So carriers, again, they're tightening, some of their benefits a a a bit, and they're tightening the rule on dual special needs plans that are eligible for OTC cards. Now it's gonna require patients to have at least one chronic condition to qualify. But most do eligible patients already do meet that bar. Right? So you'd have processors like income, UnitedHealth s three division, or nation benefits, where you can accept and process these OTC cards, which again brings more front revenue into the store. And we also have some customers that are billing for OTC consults. Right? So they're having fifteen minute conversations and billing CPT 99401 for for $30. Right? So that's why when I said before, a lot of the things that Jeff had on this slide, they're enabled by plan comparisons. Right? And it's a gateway to realizing some of these opportunities, especially on the, advantage side. And third is the prescription side. A lot of patients are gonna chase $0 premiums. Right? And that's how WellCare captured 43% of the market, because their value script plan across most states was a $0 premium. So with this consolidation, many patients are gonna be left really with just that one option, which is WellCare. And we saw the reimbursements on that, right, a few slides back. It's gonna be tough for pharmacies. So if you contrast that with MA plans, about three quarters of advantage plans offer a $0 premium on the drug benefit. So when you open up, advantage plans or those comparisons, beyond PDPs, you can help patients keep that $0 premium and also find options that are gonna reimburse your pharmacy more fairly. So you're not just pigeonholed to that one WellCare plan that's bankrupting you on the on the on the brand side. You're opening up to, again, three quarters of plans that have this offering. It could be a UHC plan that's reimbursing at AWP minus 19% or some other more regional players who are also, reimbursing the pharmacy a a bit better. So so that's the big picture on why Medicare Advantage is becoming more important. That's just where the market is going, and it's about where pharmacies can find those opportunities with the current trends. So, Jen, I'd like to bring you back in here and, see, how do you think about Medicare Advantage Plans in your pharmacy? Are you starting to see more patients on these plans? And how does that shape the way you approach, plan reviews? Yes. We are seeing quite, quite a few medical advantage. Just being able it's a lot easier for a lot of our patients whenever all of their benefits are under one instead of trying to figure out all the different supplements with the plain the plain Medicare. And whenever we're switching or using the EnlivenHealth, one to compare plans. A lot of times, those patients wanna stay with the Medicare Advantage, so we'll make sure that, we take that in consideration when comparing those plans for them because they do like the benefits of adding vision or total, altogether in one. Yeah. No. Absolutely. And there's a reason these plans have grown in popularity and, you know, one, again, is a $0 premium. But, again, these additional benefits that aren't offered on the original Medicare side. So as Jenna said, vision, dental, hearing, OTC cards. Some of these plans have in the past offered doctor, Uber rides to the doctor or vacuum cleaning for COPD patients. So they have a lot of these grander, benefits. So, again, that's some of the levers that advantage plans are pulling this year to kinda, adjust to their margins and improve their margins. But so many of these, you know, dental, hearing, they're a mainstay on these plans, and we're expected to continue to see these types of plans, just continue to grow, right, the next, few years that we saw the the estimate from the CBO. And, you know, I wanted to bring it back to the to the to the clinical services piece. Right? Because this is where plan comparisons, again, becomes a a gateway for pharmacies is helping align patients to plans that open a door for more billable clinical opportunities. So with our medical billing solution, you know, we're seeing that most of these opportunities are for seniors. Right? Seventy four percent of successful medical billing claims with our solution are tied to Medicare patients. So, again, plan comparisons, huge retention tool, but it's not just about that. Right? They set you up for deeper conversations with patients that are gonna create these pathways, to billable services, and they're gonna strengthen your pharmacy's, bottom line. So when you connect the dots, you know, again, plan comparisons help you retain Medicare patients. Retention drives more opportunities for clinical services and reimbursements. It's all tied together. So so, Jenna, since you started offering plan comparisons, what changes have you noticed in terms of loyalty, patient loyalty, refills, reimbursement, or even new services that you offered? We've definitely seen increase in loyalty. Our customers just, they've seen me since I was a baby. So they, trust me and they know that, but the newer ones that are coming in, they're more, loyal because they know that we're going out of our way to, help benefit them the most the following year and, give them all the information and educate them as well with all this information that can be really confusing for them. And so they really appreciate that as well as it does help with refills because if the patients can't afford their medications or even their premiums, you know, the high dollar brand names where they're paying, large co pays, they're gonna stop taking the medication because they can't afford it. And so when we can help them to plan ahead for the following year and be able to afford those brands, that helps a lot. As well as, of course, on our side with re increased reimbursement, you know, when those plans come out and, how they're gonna be reimbursing, really trying to compare with the ones that will work for us. And so doing that in in combination with finding what's best for our customers, that helps, helps them tremendously. And then also when I see them in the grocery store, I don't get yelled at for not helping them, you know, keep their medications coming. So, yes. And it is nice because we also educate them at the senior center with our our plans on, So even if they are our customer, we also, help them get the plan that they need when we go to senior center also. So you're able to still safely walk the grocery in your town. Yeah. That's awesome. And, you know, everything we're talking about, clinical services, retention, MA opportunities, it all comes down to, you know, as Jenna said, building, lasting patient relationships. And and there's some real data behind that. You know, when patients receive a plan comparison, ninety seven percent of them are are continuing to fill at the pharmacy, the following year. Compare that to seventy six percent who didn't who do not. Right? So retention is almost twenty five percent when you're not doing plan comparisons. You're almost keeping all your patients when you do are offering that service. And again, helping them find a more suitable plan. And the bonus is just being able to optimize for what you're being reimbursed with. Because the unfortunate truth is the insurance plans, the PBMs, they're setting your revenue. Right? So this little maneuvering is what allows you to then see within that those those reimbursement rates that these PBMs have where the best fit would be for you for a given patient. Because generally speaking, you can't you can kinda say, hey. This plan reimburses me better. This plan reimburses me worse. But once you plug in an actual patient's trunk profile, then you really find those opportunities where, you can move the needle by just switching, you know, 10 patients to something that's, more viable for your pharmacy. So, another question for you, Jenna, is you can share an example of the time you were able to help one of your patients find a better plan, you know, maybe a situation where it really made a difference for them and and for your pharmacy? Yes. So one that I had in mind was it was a WellCare patient and, the reimbursement for us was terrible, But also the patient was paying, large co pays on their brand name medication, and then they would hit the donut hole and pay even larger. And so, the patient was really struggling for the following year, and so we were able to help them find, AARP, which was a huge change with the premium and, knowing that they were going to, you know, hit that max amount and, in the following year. So they were really thankful for that brand as well as their generics went down, and, we were also helping them to qualify for dual in dual income because they weren't aware of that based on their income. So we helped them also to, lower the co pays even more with that as well by doing just the comp plan comparison. That's awesome. And and that's what it, you know, does because you're when you're having a conversation, it's not simply about moving a patient from one plan to another, but you really get to that to to some of these pain points that patients are are suffering with. Right? Is it, you know, why they're not adherent or, you know, why are some of the things that they're that they're struggling with or, you know, their doctor is out of network. They can't afford their their co pay. Right? A lot of these things get uncovered when you have somebody's deeper conversation, then you layer in some other things that you're offering. Consults, you know, some of the stuff you're doing at the senior center really opens patient's eyes to the importance of looking at their plan options. And, really, it's not gonna be it it's more important this year than any other year just because of the you know, we went over the numbers. The amount of change or musical chairs that we're expecting where patients are gonna have that gap. And because carriers aren't looking to grow so much, they're not gonna be doing a lot of outreach to to patients. Right? So it really, provides a gap for patients or pharmacies to fill with having those conversations. And, again, we know that opens it up to a whole layer of things. So depending how involved your pharmacy is with clinical services, with driving your front end, just tying that all into plan comparisons. It, again, becomes a gateway and an enabler to a lot of these, services that you're offering that you're you're looking to grow. Right? I'm sure in 2026, a lot of pharmacies are looking to grow their clinical services, looking to differentiate from PBM revenue, and it all of them is gonna start with the work you're doing now. Again, so, Jenna, I think few slides there, you put it really well where, like, you know, a lot of the things you're doing now, it's setting yourself up for for 2026. Because once someone comes in in January and they're filling to WellCare and you're seeing a loss, you know, could that patient have moved to a better plan during AEP? Now is the opportunity to to to really, drive that point forward and make sure that these plans are aligned with, the patient's needs and and and, of course, your needs. Right? If you're not open next year because you're not able to, to to fill at these rates, then community suffers, patient, you know, patient obviously suffers. So these conversations just open everything up for the patient and the pharmacy. And, so, you know, I think we kinda touched on this already, but seems like, you know, we saw some of our numbers. Curious, you know, have you seen something, as eye opening as, you know, maybe not have the numbers in front of you, ninety seven or seventy six percent. But do you see that, hey, patients you're continuing to have these conversations with, that they're coming to coming back to you every year, not just filling with you, but coming back with plan questions every open enrollment. Oh, yes. Definitely. We see, cuts even with other pharmacies that don't offer it, you know, Walgreens, Walmart, they don't have the time to take for their, customers. So we're able to they come in and ask questions. And then once we're able to share those the information with them and do a plan comparison, they're, more likely to switch over to us. Of course, we have those ones that don't, but, still able to help them. And so, yes, we have definitely seen retention. They're grateful for those extra service and extra help that we are able to offer them. That's awesome. That's a great, you know, real world example. Now another thing we we we've heard this year too is, you know, we've seen a lot of chain closures. Right? Rite Aid shut down, and we had a lot of Rite Aid patients looking for a new pharmacy. So patients were little apprehensive about just taking on that growth because they're like, wait. I don't know what what what are they gonna reimburse me? Like, I don't wanna just take on you new scripts if they're gonna if they're gonna be losers at the pharmacy. So, if they were due eligible, what a pharmacy pharmacies were doing, some of our customers, is they were as part of the intake process, they were saying, hey. What plan are you on? And if they're due eligible, part of that process is finding a plan that's viable for the, again, for the pharmacy and the and the patient. We know that's all regional. You know, Rite Aid's closure were only affecting certain parts of the countries, but we have seen a good number of chains closing. And, you know, we know pharmacies are are carefully taking in that growth. Right? Not just saying, great. We're gonna take on everyone, but really being picky and choosy about which patients are taken in. And if they could have an impact on the plan that they're on, then they're having those conversations, with with the patients. So definitely appreciate you sharing that, Jenna. Again, it's a real world example of what kind of impact these comparisons could could have. And, you know, speaking of impact, you know, we touched a little bit about this today, but next month, we will be expanding a bit on the hidden profit centers of Medicare Advantage, again, clinical services, OTC cards, finding better reimbursing plans that have a $0 premium for the patient. And you could use a scrolling link below to, register and and join us for that session. So I did see the chat was popping off a little bit. I wanna go ahead and, lead off some of the questions that we have. Some of them, you know, Jeff, maybe for you, some of them for for Jenna, but I'll try to direct them in the right way. So first question is, if I'm losing money on a prescription, this is from Josh, what am I legally allowed to tell a patient? I was told that if we tell a patient that we're losing money on our contract, it could be voided. Is this true? I know in the past, the PPMs have had these, these gag order clauses, right, that I think, speaks to your your question here, Josh. I believe in some states, you know, some, state governments have taken some measures to to minimize that. I know what a lot of pharmacies do is, you know, they don't have that on stock or, you know, they just don't carry those medications that are big losers for the for the pharmacy. So, yeah. You know, Jenna, you know, I'll throw this one out to you too. You know, what what do you do in this situation? How does that conversation go when you're, feeling a big big loser for with a patient? I just kind of, educate the patient on it of how, the insurances are operating and bringing the news as well, because a lot of times these PBMs have been making a lot of a lot of headlines. And so just kind of informing the patient too of, like, this is how what's going on, and, I just like to inform the patient of how it's going. A lot of times, I also have to calculate in, you know, is a patient getting multiple prescriptions with me, or is it this one prescription? Is it, balancing out or not with this one that's, you know, not reimbursing well? Yeah. And then again, I guess to add to it as well, you know, if it's Medicare patient, then making sure to write them down, discussing with them about, hey. Let's look at to a plan. You know, I might be losing money right now. If it's still eligible, I can switch them for the next month. Or if it's for the following year, then we can discuss it and, hopefully, change that around for the following year instead of losing a whole patient and their whole profile. Yeah. Absolutely. You lose a you, you know, you wanna look at the patient comprehensively. Right? So if there is some other things that you're that are driving revenue within that patient, right, nutrient depletion, as Jeff mentioned before, it's really looking at that patient comprehensively and seeing if, you know, if you do happen to lose that patient, what that means, like, when you look at the PBM revenue, potential clinical revenue, front end revenue. But, certainly, if it comes down to that situation where it's unsustainable for you, you know, again, I know some pharmacy just won't carry somebody's medications, so they're unable to to fill them. So I I think you, you know, certainly could be somewhat honest with the patient, but you also wanna protect yourself, with, some of the things you may have in inventory so that, you know, when you're saying these to the patients, they're they're truthful statements. Marvin, if I could jump in there, two, great comments from both of you on that. If you're an American Pharmacies member, I highly encourage you to reach out and speak with American Pharmacies general counsel Miguel Rodriguez. He's very knowledgeable. He's accessible to you. I highly recommend that you have that conversation with him. But to Marvin's point, you know, extending patient revenue in different ways, that's important as well. If you have the capability and, through EnlivenHealth's, myDATAMARK platform for American Pharmacies members, that's, Rx Compass, you can actually evaluate the full value of individual households, patients who are reside at the same address. And, possibly, there's other folks in the same household that can make up for for reimbursement for one or more medications from, another patient within the same household, if that makes sense. Absolutely. Yeah. Thanks for that, Jeff. And, yeah, speaks to a lot of the work American Pharmacy is doing right on the advocacy front. A lot of these questions, yeah. And, you know, Lynn Miguel at the AP show at Apex this year and very knowledgeable and very dedicated as, all of American pharmacies is with with driving, independent pharmacy forward. Thank you for that, Jeff. Another question we had here from Raul is, are there more opportunities on the medical benefit versus PBM? I just don't see enough money when we bill for meds. We're trying to limit the poor Rx reimbursement. I heard of CSAO that are helping with contracting credentials. Do you work with them? Alright. So there's a lot there. So there certainly are. I think we spoke. Right? There's some medical, some opportunities on the medical benefit. And when you're credentialed and contracted with these carriers, you're also able to bill not just to their commercial side, but also to their MA clients. Right? So that's where we've seen some of our customers billing those Medsync consults, even those OTC consults to these MA plans. And, really, as Jeff said before, in in the context of LTC at home, a lot of times, these are things you're already doing. And same thing here. Right? Medsync, you're already offering Med sync at your pharmacy, most of you. Right? So having those consults, turning that into a subscription revenue, and and then also applying some other opportunities that may be available in in your state. So there definitely is some more opportunity there. So you're seeing patients kind of as a network to then, realize some of the clinical revenue opportunities. And the other question was about part of CSAO. So I think Raul is talking about provider CSEO who, to my understanding, they they help pharmacies with the credentialing and contracting process so that they're able to bill to these carriers on the medical benefits. So you do need to be contracted with them in order to to bill with them, as a provider, to be able to bill on the medical benefit. I'll jump in on this one too, Marvin. Thank you for that that input. Yes. There to my understanding, there are a greater number of, claims that you can bill for on the commercial side. So something to be mindful of for those patients, applicably. And then for provider CSEO, American Pharmacies is partnered with provider CSEO. To Marvin's point, they're a great resource to help pharmacies get in network with commercial payers. You know, basically, you just tell them which payers you're looking for, and then they go to work to help get you in network and, help you to maximize that reimbursement. American Pharmacies members do have access to unique terms and pricing with provider CSEO. And, again, if you have any questions about that, please feel free to reach out to your American Pharmacies rep or, of course, you could always contact provider CSEO specifically. Just let them know you're you're an APRX member. Yeah. Of course, Jeff. I already got a connection with them. So, and and same on the match side, right, for American pharmacy members. Right? There's special pricing for American Pharmacies, and we are, you know, two, three weeks away from the start of AEP. So, again, a lot of things we talked about today, it's about setting yourself up for success in 2026. So, certainly make sure you contact American Pharmacy or us directly at EnlivenHealth to learn more about that special pricing. But, you know, couple that with a lot of these other things that, you know, your pharmacy is growing into and, and connect those dots. Right? Because all this stuff, it's connected, and it's a a matter of a cohesive strategic approach moving forward. So, Danny, I think in that same vein, had a question. Do you have to be enrolled as something as something as a pharmacy to bill medicine consults? So so, yes, you would have to be, you know, getting contracted, credentialed and contracted, with these carriers. And then it depends on your state on what you're able to to bill for, and then carriers have different rules on what they will pay for or what rate at different states. So, certainly, you know, big opportunity there. But, yeah, there is, some prerequisites that you have to take in order to to do that. Okay. So Carrie asked, do you run into a problem with MA plans for the with the patient's PCP not taking the advantage plan? I know that's been a worry for some of my customers when looking at MA plans. So, Jeff, I'll throw this to you. I know you did some MA enrollments last AP. How do you, work around that in terms of, making sure that the doctor's in network? Yeah. The EnlivenHealth, match is great for that because it automatically, downloads all the information, doctor and pay and prescription. So it'll show you if there's a restriction on that provider. So right automatically, the patient will be able to see when you compare the plans if their providers that they already are seeing will, be covered under that MA plan. Yeah. And and building on that, you know, some of the best practices on top of that is because, you know, some of these networks that are maintained by third parties, they're rarely audited. Sometimes this information could be out out of date, because there's no real rule. I know the government is trying to get into that where they're really forcing these carriers to keep this up to date, but it seems unclear what their mechanism is to keep them on track other than just putting up a rule to say, hey. You gotta do this. So with some best practices is on top of that is even reaching out to the doctor, right, and saying, hey. I'm looking at this patient. They're, you know, looking to choose between two or three different plans. Just wanna make sure you're in network with this. Right? And that opens up some collaboration with the provider also. Right? And then after a while, you kinda know which doctors are in network, which aren't. And then, you know, as part of, being a a a Enliven how EnlivenHealth match customer, you know, we do work with, our broker. I mentioned them before, HP one. So we have reps that are dedicated to our program that can help patients with some of these questions and nuances about doctor networks, again, some some other health coverage questions, ambulance information, or, you know, just other information that's tied to the benefit. But, certainly, a lot of the additional benefit information when you do a printout side by side and you're looking at, you know, say, three plans, it does provide all that information. But we do suggest, you know, in terms of the doctor's network, that what some pharmacies do also is they'll narrow down the plans to you know, an average pharmacy could have 20 PDPs their network with 40 MA plans, and narrowing that down to about three according to their drug coverage and the drugs they're filling with you. And then having them, you know, again, completing that process with reaching out to the doctor or even having the patient, checking with HP one and they can complete that enrollment on your, behalf. But but, yeah, that is, one nuance there. So, Carrie, that's a good one that you brought up there that, just need to make sure the doctor, is in network on these plans. Connie, another question she had is, how do pharmacies accept these OTC allowance cards from NA plans? They won't go through at my pharmacy. Most of these are contracted with big chain pharmacies and groceries. So there's a few different providers. Right? Incom is one. I think they're based out of Georgia, and they process, I believe, for Humana and and Aetna. And then you have United, yeah, for Humana and Aetna. And then United owns one of these processors called s three, and they do United plans. And then you have other smaller ones like nation benefits. So they it it was you're right, Carrie. And few years ago, it was really strictly, for chain pharmacies or for mail order. But these these, processors and plans have been opening it up to independent pharmacies too. So I'd be curious to see which plans you were looking at, which processes you're working with, because those should go through. There may be some particular nuance with that plan, but to my understanding, a lot fewer of them are are are steering people to chains only and groceries only. So I'd be curious if you wanted to to reach out to see who you're using as a processor and be happy to, investigate or dig dig a little deeper for you. So Amber had another question about how do you recommend enrolling patients in MA plans when it comes down to how much they wanna pay for health coverage, ambulance ride, hospital, etcetera. So when you're comparing plans inside match, it'll show information on, that type of coverage when you do a hand side by side handout and have all these additional benefits that they have to consider. Right? The doctor network stuff, you know, we do, recommend you you do a a double check on that, but that certainly is all outlined for you when you do a handout and print out for the patients. You either review at home, come back with you to enroll, or, call the plan or HP one to complete that process. I think this one's for you, Jeff. Are you able to evaluate for a household if the entire household is not filling out your pharmacy? Good question. Unless there is dispensing activity in your pharmacy system for any given patient, no. You would not be able to see that patient's activity. Now if other folks in that same patient's household have dispensing activity or dispensing data within your system, you should be able to see that. And if again, if you have in lab adelismat, datamart, or or if you're Rx, an American pharmacies member, American Pharmacies Rx Compass, you can use it's called the patient value by household report. And very easily, you can look up the patient's address or individual patients in that household and, see the value of the household in aggregate or drill down into the individual patients to look at claim volume and get a better understanding of which drugs are driving overall performance. But but you would need at least some data from, patients within that household to get any kind of, any kind of information. Gotcha. That's good to know, Jeff. Thanks for for answering that. Akil had a question. Is there a training or whether or not on how to use match? So good question, Akil. So if you're a customer, we have a training live training webinar, that Sarah runs every Wednesday at two. So, actually, if you wanna do a dub two eastern. So if you wanna do a double header of match, you can get off here and go to the training webinar. And, if you want the link, I can send it to you right now. But, I will, make a note for actually, you know what? Let me paste it into the chat here. So that is the training webinar for customers. So, Akhil, if you're a customer, follow that link, and, you'll be able to go through the training webinar. If you're not, then I would suggest, hitting get a demo button that's on your screen or reaching out to our sales team, and they could walk you through a one on one demo on how to use it, personalize it to your pharmacy, your expectations, and what your goals are. And, you could see if you're a good fit for for, your pharmacy, a good fit for doing plan comparisons. Okay. Another one is, how do you accept the OTC benefit cards? You have the separate kiosk. Yes. So most of these processes have a separate kiosk. I think Nations Benefit tried to do some integration with Pioneer, but I'm not sure how many big carriers they have. But if you have Pioneer, I'd reach out about that integration. Otherwise, you would need a separate kiosk from, let's say, an INCOM or an s three. So Connie asked how to reach out to you. I'm in South Carolina. Lima and scan are very popular. So you can respond to the email. We're gonna send out the recording, and, the team will get this routed over to me. So if you wanted to just, reply to, you know, an email, registration that you got about this this webinar, then, they'll direct that over to me. And if you're a customer, great. We'll dig into your account. If not, I can certainly connect you with someone from the sales team. DJ asked, I may have missed it, but are you able to share the education PowerPoints? Yes. We are. So those will go out, I think, within twenty four hours of the, the webinar. Let me see if we have any other questions here. I think we've addressed most of them. Oh, here's a question from ShoMichael. There are some insurances that allow that allow out of network medical billing for pharmacy. The caveat is a platform to bill from. Generally, your pharmacy software cannot do that, for example, doc station or outcomes premiums. So I think you're asking whether you're able to bill at a network to the medical benefit, and whether you're able to do that with, like, our medical billing solution or some other, out there in in the market. And, I think that's a matter of, you know, again, getting credentialed and contracted. And, I believe with some of those entities that do provide that service that, you're able to bill out of network, while you wait to be, accepted by the carrier or by the network. Right? So, you know, I think, Jeff had mentioned also, you know, the provider CSAO. I think they would have some more details on on that. So if you certainly wanna reach out to Jeff and his team, they can connect you with someone over there. And and just to piggyback off of the your comments, Marvin, yes. You can bill out of that payers. Of course, the reimbursement will be lower than for pharmacies who are in work. So something to keep in mind in there. Yes. There are a host of different billing solutions out there now. I've even heard of some pharmacies who are billing directly from the payer portal, which would be unique and, different for each payer. Not as user friendly as you can imagine, but there are some options there to help assist with that, including if if cost is an issue, you can go directly through the payer portal. But I would not recommend that as a long term solution. It's just not going to be efficient enough, for a program that would be in addition to your primary workload of of filling prescriptions. Yep. Thanks, Jeff. That that certainly makes sense. So so yeah. Definitely looks like a process that can hold you down in the short term. But in the long term, we'll, you know, have to just, find a more efficient way to to to do that. And, you know, we have I have to say so, Michael, I mean, we we do have a treat service. You know, if you're a, American Pharmacies Syncora customer, you know, there are some, partnerships we have there on the Syncora front. So you can look at us in addition to some of the other two, two other companies that you mentioned there and and, compare, you know, what that process looks like, and maybe this one fits a little better into your workflow. And, correction, actually, DJ did not he doesn't want these slides, he said. He wants doctor Jenna's slides from the education PowerPoint. So, Jenna, I'll throw that out to you if you wanted me to connect you with this, attendee that was curious about your presentation and the content for those senior, monthly sessions. I actually don't have any slides. It's just more of a one on one, just sitting down with them and discussing with them their medications and showing proper blood pressure. So I don't I don't have any slides. It's off the dome. So no slides. She freestyles it. So but definitely, I mean, that that's a great event because, you know, being able to connect with people like that outside of your pharmacy also kinda changes the tone of the conversation a bit. Right? Sometimes when someone's coming to your pharmacy, they're coming for one particular thing, and it allows you to talk about, the patient in a more general way. So let me see. K. DJ says he's got it. And, I think those are all the questions. So, thanks everyone for joining us today. Jeff, Jeff, thank you so much for taking time out of your day to join us. We appreciate your time and the work that you're all doing, for your patience every day. So we hope you have a great rest of your week, and I hope we see you at the next webinar. Thanks, everyone.