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The Top 3 Benefits of Comparing Plans for Dual Eligible Patients

Posted on February 2, 2021 by Amplicare Team

Did you know that 25% of Medicare patients are dual eligible?

That’s over 12 million people!

So, for the pharmacy looking to lower DIR fees year-round, as well as improve care and increase retention, understanding how best to serve these patients is essential.

With four quarterly windows to enroll or switch plans, you can provide the same win-win benefits for your dual eligible patients - and your bottom line - as you can during the regular Annual Enrollment Period.

But let's go over the basics first.

Who is a dual eligible patient?

A dual eligible patient is a person who qualifies for both Medicare and Medicaid, or who receives extra help from Social Security.

With fixed maximum copays, they pay $0 in premiums and deductibles which means their out-of-pocket expenses are fairly consistent.

Additionally, many of these individuals require an increased level of care:

  • 41% have at least one mental health diagnosis
  • 49% receive long-term care services
  • 60% have multiple chronic conditions

It’s clear from the stats above that dual eligible patients need additional attention from both you and your staff.

By focusing on plan comparisons throughout the year, you can offer simpler solutions that not only help these patients, but improve your pharmacy’s bottom line as well.

Let’s discuss exactly how that works.

1. Successfully managing patient care while lowering DIR fees

In some cases, dual eligible patients may benefit from switching to a plan with a lower cost or better coverage, such as a higher CMS rating or fewer drug restrictions.

However, because these patients have fixed maximum copays, that means there's a lot of flexibility in helping them find a plan that:

  • Saves them money
  • Increases your pharmacy's reimbursements while lowering your DIR fees

Working with these patients outside of the Annual Enrollment Period allows you to take effective action and help patients save on cost or gain improved coverage without sacrificing care all year round.

2. Providing enhanced year-round guidance and improved care

As we mentioned above, dual eligible patients have unique, year-round enrollment options.

While the Annual Enrollment Period is only from October 15 – December 7, dual eligible patients have four windows (once per quarter) to enroll or change their plans.

That means your pharmacy can get the same benefits from comparing plans all year that you do during Open Enrollment by focusing on helping dual eligibles. This includes finding a plan that works best for their unique situation.

And the number of dual eligible patients is growing fast.

In 2006, the number of dual eligible beneficiaries was 8.6 million. In 2018 the number jumped to over 12.2 million.

Having a pharmacy software solution that identifies dual eligible patients, and makes setting up plan comparisons easier, can improve retention and save you time throughout the year. 

With fewer headaches and the peace of mind that you can effectively fight DIR fees all year, you can focus on what matters most — improving patient care.

3. Freeing up time by reducing prior authorizations

Dual eligible patients are more likely than other Medicare beneficiaries to take medications with plan-imposed restrictions, such as step therapy requirements or prior authorizations. 

Documenting and monitoring these prior authorizations can be time-consuming and exhausting.

Helping your patients find a plan with fewer restrictions frees up time to focus on patient care and ensure continuity of therapy.

So, how can your pharmacy take advantage of the benefits of helping dual eligible patients?

It’s simple.

Amplicare offers the most comprehensive pharmacy software solution on the market to help strengthen the health of both your patients and your bottom line, especially when it comes to dual eligibles.

With an easy-to-use platform, our tools help you:

  • Strategically identify dual eligible patients
  • Help patients quickly compare plans - even safely from home
  • Detect win-win opportunities for you and your dual eligible patients
  • Increase patient retention
  • Automatically highlight opportunities to lower your DIR fees all year

Now is the time to determine if your pharmacy is set up to help dual eligible patients compare plans year round.

Interested in learning more? Take our free assessment below and discover how Amplicare can help your pharmacy better serve dual eligible patients and your bottom line today.

[Take the Dual Eligible Assessment]


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