Agents can be a valuable resource for you and your patients

Transcription

1 Navigating Agents can be a valuable resource for you and your patients by Jennifer Bruckart Ernie Moxey, RPh, remembers a time not so long ago when almost all of his patients paid cash for their prescriptions. Moxey first opened his Medicine Shoppe pharmacy in 1980 with his wife, Lisa, in the rural farming community of Sikeston, Missouri, population 16,992. Back then, terms such as co-pay, premium, and TrOOP were unknown to his senior patients, the majority of whom also were enrolled in the state s Medicaid program. James B. Ritter 16 america s Pharmacist September

2 the Medicare Anthony Budde, RPh, counsels a patient in Bethalto, Illinois. September 2009 america s Pharmacist 17

3 Now, like 45 million other Medicare eligible beneficiaries nationwide, his patients must navigate the complicated maze that is the Medicare Part D program. We still have Medicaid patients who do not realize they are enrolled in a Part D plan, Moxey says, illustrating just one source of confusion among Medicare beneficiaries. Across the Mississippi River, Anthony Budde, RPh, has been around pharmacy for more than 30 years. As pharmacist manager for the past 10 years of Rinderer s Home Health Care Pharmacy in Bethalto, Illinois with 9,454 residents he too has seen how Part D has affected his patients since it debuted in It s so complicated that the average person who is eligible for Part D does not understand the complexities of the program, Budde says. They don t have a clue where to go or what to do. A lot of them don t have a computer or Internet, much less know how to use them. This can make choosing a plan particularly difficult in a state such as Illinois that has almost 50 prescription drug plans, not to mention 199 Medicare Advantage plans with and without drug coverage (availability varies by county) from which seniors can choose. When it comes to selecting a Medicare plan, many patients head straight to their local pharmacy for help. Often, those visits begin as soon as the patient turns 64 and starts receiving letters from Medicare. Once they turn 64, they are bombarded with literature, and they re totally confused, Budde explains. Budde and his staff try to assist their patients as best they can. But he admits his primary goal is to give them the basics, point them to the available resources, and allow them to make the most educated decision. With our customers, we have tried to assist them and at least educate them on their choices and what they have to do to enroll, he says. Local Experts The good thing is that pharmacists do not have to tackle patients Medicare questions alone. There are a number of resources that they can use to educate patients about their enrollment options. This includes the Medicare Plan Finder Tool, available at as well as private plan Web sites and marketing materials approved by the Centers for Medicare & Medicaid Services. In many cases, I simply act as a referral, Budde explains. I tell them about their options and try to act as a consultant Ernie Moxey, RPh, at his pharmacy in Sikeston, Missouri. to refer them to the proper people who can help them. This often includes the local Area Agency on Aging, the Illinois Senior Health Insurance Program (SHIP), and local senior centers with experts on staff to assist with questions. The selection process is even more complex when it comes to Medicare Advantage. These private insurance plans include medical coverage something most pharmacists agree they don t really understand. That s where licensed insurance agents can provide a valuable service to pharmacies. These trained professionals are knowledgeable about all plan types from basic prescription drug plans to Medicare Supplement plans to Medicare Advantage plans with and without drug coverage. In addition, CMS guidelines require Medicare Advantage enrollments to be taken by a licensed agent who can help explain the complexities of these plans. It All Starts with Trust Working with an agent can be a sensitive issue for pharmacists, many of whom have long-standing relationships with their patients. Pharmacists are often nervous to refer a patient to an agent who may not have the same commitment to the patient. David Pittaluga of St. Louis, a licensed career agent with Universal American, plan sponsor of the Community CCRx SM Medicare Prescription Drug Plans, works with about 10 independent pharmacies in Missouri and Illinois, including Rinderer s. He says he can appreciate the value of the patient-pharmacist relationship. What I ve found is that people really trust their pharmacist, Pittaluga says. If a pharmacist gives you scott welton September 2009 america s Pharmacist 18

4 Reminder: CMS Provider Marketing Guidelines The 2010 Annual Election Period begins Nov. 15, It is important to keep the following in mind when conducting any outreach to potential Medicare enrollees. Providers CAN: Provide the names of plans with which you participate. Distribute Prescription Drug Plan (PDP) marketing materials and enrollment applications after Oct.1, Providers may also distribute plan information material about Medicare Advantage plans combined with Prescription Drug coverage (MAPD); providers cannot distribute MAPD enrollment applications. Display promotional materials that announce a provider s relationship with a plan. Provider affiliation banners, displays, brochures, and/or posters located on the premises of the provider must include all plans with which the provider contracts. Use direct mail and/or to announce a new plan affiliation but only once. Additional communications must include ALL plans with which the provider is affiliated. Display plan specific benefits that have Centers for Medicare & Medicaid Services (CMS) approval. Distribute printed information provided by a plan sponsor to patients, as long as there is no ranking or highlighting of specific plans. (Providers must accept and display all plan information equally and must be contracted with that plan). Distribute CMS-approved plan finder information; providers also may share information with patients from the CMS Web site, www. cms.gov, and/or the Medicare Web site www. medicare.gov. Provide leads to plan sponsors, provided the pharmacy adheres to all state/federal laws and follows all HIPAA regulations and does not include any health-screening information or cherry-picking. Providers CANNOT: Direct, urge, persuade, steer, or offer inducements to join a particular plan. Compare plan benefits against other health plans, unless created by CMS. Collect or accept Medicare enrollment applications of any kind. Distribute MA and/or MAPD enrollment application forms. Use third party sales or plan promotional materials that are not CMS-approved. Expect or accept compensation for conducting enrollment or marketing activities. If you have additional questions about provider marketing guidelines, contact NCPA at jb permission to come into his or her store and talk to patients, it s really an honor. That level of trust starts with the agent s first visit to the pharmacy, but it goes beyond that initial meeting, he explains. Pharmacists see a lot of salesmen come in and out of their store. To be successful, an agent needs to go in two, three, four different times. Pittaluga makes it a point to stop by the pharmacy each time he s in the area. That s how solid relationships are formed. He also advises agents who are considering working with pharmacists to call the pharmacy first to determine a good time to visit. Pharmacists are busy people. Agents need to ask them when their busy times are. And remember, you re walking into their business. You have to respect that. Putting the Patient First Pittaluga says his number one goal when sitting down with a client is to educate them, whether they decide to buy from him or not. I m happy to sit down and talk to them, and give them the information they need whether or not they enroll in one of my plans, he says. Pittaluga explains that when he talks with a client, he conducts a personal needs assessment and gathers all the 19 america s Pharmacist September

5 James B. Ritter Agent David Pittaluga (right) and Anthony Budde, RPh, review a patient's medication profile before discussing Medicare plan options with the patient. necessary background on the patient, including income and current insurance coverage. Many customers don t think they have any alternatives to their current coverage, he says. We try to understand their needs and explain their options. Pittaluga recalls a recent experience with an elderly client who was struggling to pay an expensive monthly premium for a group insurance policy from his former employer. After Pittaluga explained the various coverage options, the man decided to enroll in a Medicare Supplement plan with a premium nearly 60 percent lower. The coverage was almost identical to his former employer s plan. Pittaluga also talked to him about adding prescription drug coverage during the Annual Enrollment Period in November. Many people don t know what their options are, Pittaluga says. They often go without things that they want or even need. We try to give them options. At his Medicine Shoppe pharmacy, Moxey says he has had similar experiences working with licensed agent Mike Jackson, who also works for Universal American. When I first met Mike, he told me that when he went to meet with a patient, if he could not better their situation, he would not sell them a policy just to be making a sale, he explains. Since he began working with Jackson last year, Moxey said he s been pleased by the agent s honesty and straightforwardness with his patients. He would work diligently to find the best Part D plan solution for each individual and not just sell them a bill of goods as we have seen done with so many other companies. CMS guidelines have become stricter when it comes to how agents can contact Medicare beneficiaries. Patients must initially request the services of an agent, who must then call to set up a meeting time and verify what products will be discussed. This prevents aggressive agents from selling unwanted products or services, one of the early criticisms of Medicare Advantage plans. A Mutually Beneficial Relationship Many pharmacies that work with agents consider this a value-added service they are able to offer their patients. At Rinderer s Home Health Care Pharmacy, Budde and his staff scheduled weekly agent visits during the Annual Enrollment Period and advertised the availability of a Medicare expert who would be available to answer questions about Part D. Pittaluga or a member of his team would set up a table away from the dispensing area where patients could come to ask questions. He was there basically to answer their questions and inform them that he was available and could meet them at their home or some other place to go into more detail, if they so desired, Budde says. Budde has seen other benefits from offering this helpful service. Since his ads run in several local papers, people who are not regular pharmacy customers also come in to talk to the agents, which is great exposure for his pharmacy. Moxey agrees that having that expert available has been a huge help for his patients, many of whom were forced to go without much-needed medications before the advent of Part D. Medicare Part D opened the availability to a great number of seniors who needed prescription medications, but there is still an awful lot of opportunity for confusion out there, Moxey says. Having someone who can explain the differences between the various Medicare plans and help our patients choose the best plan for them has been invaluable to our patients. Jennifer Bruckart is director of program outreach for Community CCRx SM. She can be reached at jennifer.bruckart@ncpanet.org. Community CCRx is an approved Medicare Part D Prescription Drug Plan sponsored by Universal American Corp. September 2009 america s Pharmacist 20

6 america s Published by the National Community Pharmacists Association SEPTEMBER 2009 PHARMACIST T H E V O I C E O F T H E C O M M U N I T Y P H A R M A C I S T Navigating Medicare the PHARMACIST Lawmaker AUTOMATION INVESTMENT MTM OPPORTUNITIES