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Latest news and updates about the Medicare and pharmacy industries.

What Pharmacies Can Expect in 2021

Posted on December 21, 2020 by Amplicare Team

It’s hard to believe, but 2021 is just around the corner. As you plan for next year, it’s important to be in the know about industry trends and how they’ll impact your pharmacy in the coming year and beyond.

Each new year brings fresh challenges for your pharmacy and 2021 is no different. To help you get ahead, we’ve identified five key trends that could influence the way your pharmacy does business and plans patient care.

So let’s look ahead to help you make the best, most informed business decisions for your pharmacy - and your patients.

1. Independent pharmacy participation in preferred networks is decreasing

As a rule of thumb, patients fill medications at a pharmacy within their insurance provider’s preferred network because the copays are lower. 

However, fewer and fewer independent pharmacies are participating in preferred networks. They’re opting out of preferred networks because of struggles with reimbursements, more commonly known as DIR fees. 

DIR fees are set by the network and impact how much a pharmacy receives per prescription. These fees have fluctuated greatly in recent years, resulting in uncertainty and profit loss for independent pharmacies. 

Independent pharmacies who opt out of preferred networks will have to focus on high-quality service to keep their patients from going elsewhere. For this reason, these pharmacies should work on communicating costs to patients. 

Using the Amplicare platform, you can compare copays between pharmacies and give your patients peace of mind about the costs involved. Plus, depending on the patient, copays between a preferred and non-preferred pharmacy may not be any higher.

Fortunately, Amplicare makes it easy to clarify these pricing differences for you and your patients; it’s a win-win.

2. Regional plans with no DIR fees are increasing

In response to negative experiences with DIR fees, new regional plans without them have cropped up. Specifically, there are new plans for certain Medicare Part C plans (called MA-PD), as well as prescription drug plans (called PDP). 

Take note of these regional plans, as they can help you increase your bottom line through DIR fee savings. Some networks are even highlighting these plans in their communications to appeal to pharmacies.

Some plans that have gained recognition for having no DIR fees include Indy Health and Exemplar. To make the most of these cost savings, you should check whether these plans are available in your area - and how they can positively impact your bottom line.

If you have plans that involve DIR fees, you’ll also benefit from understanding and calculating them upfront. The Amplicare platform can streamline this process with DIR estimates for every plan, as well as reports that identify cost-saving opportunities for both your pharmacy and your patients. 

Tip: Open Enrollment isn’t the only time to focus on plans. All year round, you can give dual eligible and newly eligible patients a hand in selecting or switching plans by using the Amplicare comparison feature.

3. Premiums are projected to go up 9% to $41

As you estimate cost changes from year-to-year, you’ll want to consider premiums. In 2021, experts project that premiums will go up 9% to $41. 

While costs change depending on the year, this estimate serves as a bellwether to understand potential premium increases in the future.

At the same time, you can expect increases in copays and deductibles. Get the full story on pricing changes here.

4. Big-box chains are becoming more active with Medicare comparisons

Medicare comparisons are an essential part of providing great service to your patients - and big-box chains are taking notice. 

Big names are starting to offer Medicare centers and broker markets. For example, United Healthcare has opened Medicare service centers in Walgreens, while Walmart has started selling Medicare plans.

While this may mean more competition, independent pharmacies have the advantage of building a personal relationship with patients. You can create a competitive difference by offering high levels of service. Thus, building trust with your patients is even more important than ever in 2021.

5. Use of compliance packaging to address non-adherence will increase

Pharmacists know too well the cost of non-adherence, i.e., when patients forget to take, refill, or pick up their medications. That’s because DIR fees and performance metrics are based on the pharmacy’s overall adherence levels.

Compliance packaging helps pharmacists ensure patients stay adherent by organizing all their medications by time and dosage. It’s an excellent way to reduce DIRs, while also increasing patient loyalty. As you can imagine, patients are often more committed to the pharmacy by participating.

With chains and online pharmacies like Amazon PillPack and DivvyDose increasingly offering compliance packaging, patients are becoming more familiar with the service. This makes it easier for independent pharmacies to talk about it with patients and enroll them in a compliance packaging program.

At the same time, compliance packaging can strengthen collaboration with doctors, who are also invested in their patient’s health. Working together, doctors and pharmacists can help patients become even more adherent, which ultimately benefits everyone.

2021 is sure to have its ups and downs, but now that you’re aware of these five top pharmacy trends, you’ll be better prepared to face the challenges ahead.

Want more details about these trends? Watch Amplicare’s recent webinar about what pharmacies can expect in 2021.


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