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How to Increase Your Pharmacy Revenue During Medicare Open Enrollment

Posted on November 4, 2020 by Amplicare Team

It’s that time of year again — Medicare Open Enrollment. Which, believe it or not, is the perfect opportunity to boost your pharmacy’s revenue.

Perhaps you were hit with high DIR fees this year and are looking for opportunities to reduce them as much as possible (which can be done, read on to see how below). Or perhaps too many patients brought up concerns about the rising prices of their medications and are considering switching pharmacies in the belief that might lower their costs. It’s also possible that you’re struggling with patient outreach due to the COVID-19 pandemic and social distancing, which has impacted the Medicare-eligible community especially hard.

During Medicare Open Enrollment, you can address these issues (and more) to both increase your pharmacy’s revenue and save the patients you care for money in the process — as long as you have the right tools for the job.

Below we’ve highlighted the most important steps from our new Ultimate Guide to Medicare Open Enrollment, which covers key strategies for how to increase pharmacy revenue this enrollment period and provide better patient outcomes. So let’s get started!

1. Help patients compare plans — even while social distancing during COVID-19

First of all, patients need to know their options in order to make the best decisions for their physical and financial health.

With the help of Amplicare’s plan comparison tools, you can guide them through their options using patient and pharmacy data, as well as plan information to estimate costs for both your patients and your pharmacy.

Then, you can communicate the cost-saving opportunities and available care options to your patients with Amplicare Navigate — our online comparison platform that lets your patients view their options and ask you questions from the safety and comfort of their homes. It’s ideal for adapting your pharmacy’s workflows and protecting patient health during the realities of the COVID-19 pandemic.

Giving people the tools and options they need to make effective choices will result in greater retention, happier patients, and greater profits for your pharmacy.

2. Identify win-win opportunities for your patients and your pharmacy

One of the most effective tools our platform offers for increasing your pharmacy’s revenue during Medicare Open Enrollment is the “Win-Win Report.”

Using patient and pharmacy data, the Amplicare platform identifies cost savings that are mutually beneficial for you and your patients — letting you find opportunities where you both save on costs without sacrificing quality of care.

We created the Win-Win Report specifically at the request of pharmacists like you who know how overwhelming it can be to review the thousands of possible patient care scenarios and help deliver the quality care and cost savings you strive for.

That’s why Amplicare helps you identify high-value opportunities that are a win-win — good for you and your patients — to help everyone save time and stress while building lasting pharmacy-patient relationships.

3. Mitigate DIR fees with the latest insider tactics

DIR fees are always top of mind during Medicare Open Enrollment — or at least they should be.

Depending on your particular patients’ needs and habits, you can increase your pharmacy’s revenue by implementing a handful of tactics that will lower your DIR fees by guiding patients to plans that are mutually beneficial for you both.

First, you’ll want to look for plans that set DIR fees based on your store’s performance — not at the PSAO level — so you’ll have more control over them.

From there, you can manage your store’s performance to maximize the key metrics that influence your DIR fee rate. Here are a few specific strategies to accomplish this:

  • DIR Mitigation by Migration: DIR fees are often impacted by medication adherence. To reduce these fees, you can match patients with plans based on their adherence levels and prioritize plan comparisons for these patients. For high-adherence patients, you’ll want a plan that rewards them (and you) for this. For low-adherence patients, you’ll want a plan with minimal adherence penalties - in addition to working with them to improve adherence next year!
  • Identify opportunities to boost performance metrics through patient interventions: Medication adherence (the rate patients stick to their prescription regimen) is a key metric used to assess performance and DIR fees. By sending refill reminders or addressing side effects in patients, you can have a direct impact on adherence and thus your bottom line and your customer’s health. The Amplicare platform can help you identify and make positive interventions for your patients while simultaneously increasing your pharmacy’s revenue through cost savings and improving your quality of care.
  • Contact newly eligible and dual eligible patients to maximize opportunities: Newly eligible and dual eligible patients are two key patient groups to focus on during Medicare Open Enrollment. Those who are newly eligible may need extra help navigating plan selection as this is their first time evaluating their Medicare options. From the start, your pharmacy has the chance to provide real value in helping them find the most affordable and comprehensive plan for their needs. With your dual eligible patients, who can switch plans outside of Medicare Open Enrollment, this is still a good time to help them find a plan that may be a better fit for their needs than their current plan.
4. Take advantage of Amplicare features this fall

Amplicare has a suite of features that can positively impact your bottom line. As you guide patients through Medicare Open Enrollment, make use of these tools to provide an even better level of care and boost revenue:

  • The Formulary Lookup tool lets you compare a specific medication’s costs across plans.
  • The Doctor Lookup tool lets you check that patients’ preferred doctors are within their plans’ network.
  • The Drugs Not Covered Next Year report helps you identify changes in coverage for the next year that may influence plan selection.
  • The Most Valuable Current Patients & Patients Slipping Away reports help you focus on patients with high-value, win-win opportunities, as well as patients who are falling through the cracks (often because their plan doesn’t fit their needs well enough).

Ultimately, patients are 30% more likely to stay with a pharmacy that performs a plan comparison for them. During Medicare Open Enrollment, you can take advantage of our plan comparison tool, plus a variety of other cost-saving features to maximize your pharmacy’s revenue while improving the quality of care you deliver.

For more details on how Amplicare can help during Medicare Open Enrollment, consult our new Ultimate Guide below for our complete approach. Want to learn even more? See why thousands of pharmacies across the country trust Amplicare with their Open Enrollment success today.

[Get Our Ultimate Guide to Medicare Open Enrollment]


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