Double Profits with Open Enrollment

Medicare Part D Open Enrollment is Still Relevant! 

I can remember when Open Enrollment was a really big event for pharmacies. Pharmacists looked forward to helping their patients wade through all the data looking for the plan that kept expenses down for the patient while still covering the patient’s current medications at a reasonable copay. 

Over the years, the plans have been slow at updating their formularies to accurately represent the plan changes in the upcoming year. It is often common to hear pharmacists say, “I don’t even start looking at open enrollment until November because the data isn’t any good at the start of the Open Enrollment period.” 

Couple the apathy towards accurate information with the fact that many plans are reimbursing pharmacies at a loss on many claims, and you end up with pharmacies who are no longer engaging with their patients around plan opportunities during Open Enrollment. 

Today, Open Enrollment is more important to the health of your pharmacy than it ever has been. With a renewed focus on two key areas, you will make your pharmacy more profitable in 2025: 

1. Long Term Care at Home 

   
   

Long Term Care at Home has become a space that independent pharmacies recognize they can stand out in versus chains and mail order pharmacies in today’s landscape. Independent Community Pharmacy is equipped to provide packaging, delivery, engagement and follow-up with patients that is necessary to build a thriving Long Term Care at Home Pharmacy practice. However, not every insurance company reimburses for Long Term Care at Home Pharmacy the same way. Some payers are offering Skilled Nursing Rates while others are just paying a higher dispensing fee.  

If you familiarize yourself with your payers and LTC@H eligible patients, you could see an increase in Gross Profit per prescription of up to 50%! 

2. Network Participation 

More and more pharmacies are choosing to “leave-it” when presented with “take it or leave it” contracts from PBMs.  I applaud them for standing up for their business. However, if you are going to opt out of an Express Scripts or CVS/Caremark network, that is only half the answer. We can all agree that not all volume is good volume and you shouldn’t be forced to sell products below cost. In addition to jettisoning plans that don’t fit your needs as a business owner, you should be doing just as much work trying to ascertain what plans generally work well for the pharmacy and the patient. Communicating with your PSAO about network changes for 2025 is non-negotiable. You need to compare current reimbursement models to proposed reimbursement models. Believe it or not… some PSAOs have negotiated better rates for 2025. 

Now is the time to evaluate what works best for you. It could potentially change the game for your pharmacy in 2025, and beyond. At Pharmacy Survival Guide we’re here for you, and we want to see you succeed.

Reach out to our guides here if you have any questions and would like a light to guide you through the dark. Learn more about what we’re doing at Pharmacy Survival guide here.