- Email: [email protected]
Impact of an open enrollment service on costs for Medicare Part D beneficiaries
SCIENCE AND PRACTICE Journal of the American Pharmacists Association 57 (2017) S225eS228
Contents lists available at ScienceDirect
Journal of the American Pharmacists Association journal homepage: www.japha.org
RESEARCH
Impact of an open enrollment service on costs for Medicare Part D beneficiaries Chelsea E. Leonard*, Frances V. Cohenour, Lindsey A. DeLoach, John A. Galdo a r t i c l e i n f o
a b s t r a c t
Article history: Received 1 September 2016 Accepted 13 March 2017
Objective: The primary objective was to determine total estimated cost savings based on a patient’s current medication regimen after comparing available Medicare Part D plans for the upcoming year by using a plan comparison platform. The secondary objective was to determine patient-centered concerns when considering a change in Part D plans. Design: Review of an open enrollment service that included a patient survey and a Part D plan comparison. Setting: This study took place at a single independent community pharmacy in northwest Alabama. Participants: Fifty-four patients eligible for Medicare Part D were included in this study. Main outcome measures: The study was a review of an open enrollment service that aids Medicare beneficiaries in selecting a Part D plan that best fits their needs. It included a patient survey and plan comparison using a plan comparison platform, during the 2015 Medicare open enrollment period (October 15 to December 7). The survey assessed patient demographics, pharmacy preferences, and cost concerns. Survey data were used to aid in plan selection and analysis to determine the most common patient-centered concerns when considering a change in plans. Results: During the open enrollment period, 54 patients compared Medicare Part D plans. The majority of participants were female (57%) and ranged in age from 65-69 years (37%) to 70-74 years (25.9%). The majority of patients reported a preference for independent pharmacies (92.6%). Deductible (40.7%) was the biggest concern for patients when comparing the main cost variables for medication insurance. The average total cost difference per patient per year showed that each patient saved an average of $1166.46. Conclusion: The analysis of an independent pharmacy’s open enrollment service determined that a plan comparison platform is a valuable tool in helping patients to compare and select cost-effective Medicare Part D prescription plans and in helping patients save money. © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.
Medicare is a federal health insurance program for patients age 65 years and older, patients younger than 65 years with certain disabilities, and all patients with end-stage renal disease.1 The Medicare Modernization Act of 2003 established a voluntary prescription drug benefit plan for patients on Medicare, known as Part D. Medicare Part D took effect in 2006, and all patients on Medicare have the option to enroll in a private plan that has been approved by the federal government. Disclosure: The authors declare no conflicts of interest or financial interests in any product or service mentioned in this article. Funding: Project funded in kind by Chad’s Payless Pharmacy, Inc. Previous presentation: Poster presentation at American Pharmacists Association (APhA) annual meeting held in Baltimore, MD, March 5, 2016. * Correspondence: Chelsea E. Leonard, PharmD, Director of Clinical Services, Chad’s Payless Pharmacy, 501 W College Street, Florence, AL 35630. E-mail address: [email protected] (C.E. Leonard).
Patients enrolled in a Medicare Part D plan are more likely to be adherent to their long-term medications than Medicare beneficiaries without drug coverage; this is thought to be due to lower costs for prescription medications.2 In 2016, more than 41 million Medicare beneficiaries were enrolled in a Part D plan, and there were 24 plans available to Medicare beneficiaries in Alabama.3 Open enrollment for patients to choose a Part D plan or change their current plan occurs each year from October 15 to December 7, and patients who are turning 65 are eligible for enrollment 3 months before their 65th birthday, the entire month of their birthday, and the following 3 months.4 Each Medicare Part D plan has a different formulary, monthly premium, copayment, and annual deductible.5 The Centers for Medicare and Medicaid Services currently has a Medicare Plan Finder feature on the website that allows patients to enter their information and medication list and compare plan options.
http://dx.doi.org/10.1016/j.japh.2017.03.005 1544-3191/© 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.
SCIENCE AND PRACTICE C.E. Leonard et al. / Journal of the American Pharmacists Association 57 (2017) S225eS228
Key Points Background: Medicare Part D is an optional prescription drug program for those eligible for Medicare. Each Part D plan has a different formulary, monthly premium, annual deductible, etc. Studies have demonstrated that patients with a Medicare Part D plan are more adherent–likely due to lower costs of medications. Determining which plan to choose can be a confusing and difficult process for patients and caregivers. There are several proprietary software platforms that simplify the Part D plan comparison process.
pharmacist using a comparison tool could replicate the stated benefits. The most recent publication is from the RAND Corporation; it suggests a need for a more user-friendly version of the Medicare Plan Finder.8 Therefore, the purpose of this study was to evaluate an open enrollment service consisting of a survey and plan comparison to substantiate the reported benefits and effectiveness of a plan comparison platform (iMedicare) on costs for Medicare Part D beneficiaries. Objectives The primary objective was to determine total estimated cost savings based on a patient’s current medication regimen after comparing available Medicare Part D plans for the upcoming year by using the plan comparison platform. The secondary objective was to determine patient-centered concerns when considering a change in Part D plans.
Findings:
Methods
The majority of patients who participated in the open enrollment service indicated that the annual deductible was the most concerning factor. Average cost savings for 54 patients who participated in the Open Enrollment service was $1166.46 for 2016. Plan comparison platforms are useful tools for helping patients determine which Part D plan to choose. Patient-centered concerns should be considered when helping a patient select a Part D plan.
Setting
Community pharmacies may not be in-network or preferred for all available plans. Several proprietary companies have developed interfaces to the Medicare Plan Finder to facilitate patient understanding. This project used one of these platforms offered in an independent community pharmacy to help patients compare Medicare Part D plans. iMedicare launched in 2012 in a single community pharmacy, and it has expanded to more than 4000 pharmacies in the United States.6 The software is similar to the plan finder on the Centers for Medicare and Medicaid Services website; however, the proprietary system syncs directly with the pharmacy dispensing software to allow the patient to see his or her current medication regimen based on the pharmacy dispensing record for each plan. This allows the pharmacist conducting the plan comparison to be more efficient and spend less time entering medications into the plan finder. The pharmacist also has the ability to deselect a medication if it has been discontinued or was a 1-time-only fill, such as an antibiotic. Some of the data available to the patient and pharmacist includes projected monthly and yearly costs, preferred pharmacy network (independent, community, mail order), and therapeutic alternatives on the selected formulary. iMedicare claims that patients who used their platform to compare insurance plans saved an average of $1150 per year.7 There are limited published data replicating the stated benefits of plan comparison programs. There is no peer-reviewed evidence supporting the use of iMedicare. Moreover, in the existing literature, no study examined whether a community
S226
The practice site is an independent community pharmacy in northwest Alabama. The pharmacy fills approximately 350 prescriptions per day and offers clinical services such as Medication Therapy Management; diabetes education classes accredited by the American Association of Diabetes Educators; routine and travel immunizations; and biometric health screenings, which include cholesterol, blood glucose, blood pressure, and body mass index assessment. Study design This review of an open enrollment service included a patient survey and Medicare Part D plan comparison using iMedicare during the 2015 Medicare open enrollment period (October 15 to December 7). The open enrollment service was offered to patients at an independent pharmacy in Florence, Alabama. Medicare beneficiaries who filled prescriptions at the pharmacy were identified through data reports generated by iMedicare and the pharmacy’s dispensing system. Patients identified from these reports were contacted by telephone, bag stuffers, and face-to-face queries about this free service. Interested patients made an appointment with a pharmacist to conduct a plan comparison using iMedicare. As part of the service, the pharmacist documented the projected costs if a patient remained on their current plan and their estimated costs if they elected to change to a different plan. Patients were also given a survey before the plan comparison that assessed patient demographics, pharmacy preferences, and cost concerns. The survey was developed by pharmacists and patients, and it underwent pilot testing by patients older than 65 years. Survey data were used to aid pharmacists and patients in plan selection, and they were later analyzed to determine the most common patient-centered concerns when considering a change in plans. For example, if a patient indicated that they wished to have a lower deductible, the pharmacist helped them look for plans with a low or no deductible. The pharmacist also took formulary restrictions (e.g., prior authorizations, step therapy, nonformulary medications) into consideration and discussed any potential restrictions with the
SCIENCE AND PRACTICE Impact of Part D plan differences on costs for beneficiaries
Table 1 Survey question results
$300.00
No. of respondents
Do you ever skip doses because of cost? Yes 3 (5.5%) No 51 (94.4%) What is your pharmacy preference? Independent 50 (92.6%) Chain 3 (5.5%) Mail order 1 (1.9%) What is your major concern regarding insurance cost? Deductible 22 (40.7%) Monthly premium 11 (20.3%) Monthly copayment 16 (29.6%) Other 5 (9.3%)
$250.00
Dollars
Survey question
$350.00
$200.00 $150.00 $100.00 $50.00 $-
DeducƟble (Yearly Average)
Premium (Monthly Average)
Co-Payment (Monthly Average)
Before
$305.56
$40.42
$204.02
AŌer
$191.11
$28.64
$122.96
Savings
$114.45
$11.78
$81.06
Key: Number of parƟcipants 54.
Results are patient reported and may not add to 100% because of rounding.
Figure 1. Impact of plan differences.
patients. Plan comparisons were conducted only with a pharmacist. Patients were given the option to remain on their current plan, switch plans at the time of comparison, or switch plans at the pharmacy at a later date after they had time to consider all of their options. Patients were included in the analysis if they participated in the Chad’s Payless Pharmacy Open Enrollment service during Medicare’s Open Enrollment period. There were no patients excluded that participated in the service.
(92.6%). Deductible (40.7%) was the biggest concern for patients when comparing the main cost variables for medication insurance. The patients who selected “other” as their primary concern either wanted to ensure the pharmacy was in the plan’s preferred network or simply wanted the plan that was the least expensive overall. When specific concerns were raised by the patient, the pharmacist discussed those concerns and helped them to select a plan that best aligned with the patient-centered outcome. Figures 1 and 2 show the cost analysis results of the study. Figure 1 shows the average difference in cost of the deductible, premium, and copayment for the participants before plan comparison, after plan comparison, and the average savings. On average, patients had a decrease in cost of $114.44 for the yearly deductible, $11.78 for the monthly premium, and $81.05 for monthly copayments. iMedicare calculates the estimated total yearly costs based on the monthly premiums and average monthly copayments with the deductible factored into the total cost. The total maximum amount saved by any patient was $6866, with the least amount saved by any patient being $20. Figure 2 is the average total cost difference per patient per year, which shows each patient saved an average of $1166.46 per year; this is $16.46 more than the $1150 claimed by the plan comparison platform.
This project was approved by the Samford University Investigational Review Board. De-identified data, including demographic information, survey responses, and precomparison and postcomparison cost data, were provided from the pharmacy to researchers at Samford University. Descriptive statistics were used to evaluate the data. Results During the open enrollment service period, 54 patients compared Medicare Part D plans. When using the service, 49 patients switched to less-expensive plans. Three patients did not change plans because they were already on the best plan for them. Two patients switched to plans that were more expensive so that they could remain in a network in which the pharmacy was preferred. The majority of participants were female (57%) and ranged in age from 65-69 years (37%) to 70-74 years (26%); 18.5% of patients were younger than 65 years, 11.1% were 75-79 years old, 5.5% were 80-84 years old, and 1.9% were older than 85 years. Only 12 patients (22.2%) were considered dual eligible. Dualeligible patients have Medicare and are eligible for some form of Medicaid benefit. Frequently, the Medicaid benefit will cover the Medicare monthly premiums, or the patient will qualify for Medicare Extra Help paying for prescription drugs, or both. Table 1 provides a summary of the survey responses obtained from patients during the open enrollment program. The aim of this survey was to determine patient-centered concerns when contemplating a change in Medicare Part D plans. A patient-centered outcome is one that addresses factors that are of importance to a patient. The survey focused on trying to identify those various factors for each patient. Only 3 patients (5.5%) reported skipping a dose because of cost, and most indicated a preference for independent pharmacy
Discussion We studied an open enrollment service that assessed cost savings for Part D beneficiaries during the 2015 Medicare open enrollment period. This research shows that patients are concerned about the cost of their annual deductible. $4,000.00 $3,500.00 $3,000.00
Dollars
Analysis
$2,500.00 $2,000.00 $1,500.00 $1,000.00 $500.00 $Average Total Cost to PaƟent per Year
Before
AŌer
Savings
$3,555.65
$2,389.20
$1,166.45
Key: Number of parƟcipants is 54. Figure 2. Average total cost to patients per year.
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SCIENCE AND PRACTICE C.E. Leonard et al. / Journal of the American Pharmacists Association 57 (2017) S225eS228
Approximately 40% of patients cited deductibles as the main cost concern when comparing insurance plans; however, the majority of cost savings emerged from reductions in monthly copayments ($114.44 average yearly reduction in deductible versus $972.60 average yearly reduction in copayments). The advent of the Patient Protection and Affordable Care Act of 2010 has caused numerous changes to the health care system. One of the benefits is the move toward patientcentered care. Community pharmacists have a role in empowering patients by helping them to understand differences between the available insurance plans. Despite numerous reports of high-cost prescriptions plans, the results from this study show that less costly options for medication insurance plans often exist for patients. Community pharmacies are often innovating practice through nondispensing services, yet few data exist to support the impact of these services. This study helps to substantiate services focused on aiding patients in selecting the best Medicare Part D insurance plan for their needs. The study found nearly identical cost savings per patient compared with the publicized amount. Community pharmacists are at the forefront of the health care field. As the United States population continues to age, more individuals are going to enroll in Part D plans, and community pharmacists are poised to provide assistance in this arena. Proprietary companies provide services that interconnect the Medicare Plan Finder and dispensing software, saving the pharmacist and the patient time and money. This research starts the literature validating the impact of these services. Further research should be conducted with larger sample sizes, different practice settings and different geographical locations, and between proprietary software offerings. Limitations This project has several limitations. Data collection occurred in a single independent pharmacy in northwest Alabama; further analysis is warranted within a large network. In addition, only 54 patients participated in the pharmacy’s open enrollment program, which is a small number of patients compared to the estimated number of eligible patients in the area and in the pharmacy. Another limitation is the concern of the pharmacy being preferred or in-network. For patients who wanted to stay with this independent pharmacy, the pharmacist discussed preferred and in-network status with the patients. Considering that pharmacys' status, formularies, deductibles, copayments, and existing plans change each year, it is necessary to repeat this service offering annually. Future research could include investigating whether the patient participated in a plan that offered medication therapy management services or vaccinations. Other avenues of investigation could include researching only dual-eligible patients or only patients interested in Medicare Advantage plans, which administer the benefits of Parts A, B, and D. Finally, research comparing insurance plan comparison platforms should be conducted to evaluate the differences among various platforms. Community pharmacists are often requested to purchase or use various platforms, such as iMedicare, to aid in the Part D plan selection; however, no literature exists comparing these platforms to help pharmacists select a tool that will be helpful for them and their patients.
S228
Conclusion iMedicare was found to be a valuable tool for the open enrollment service at Chad’s Payless Pharmacy. Pharmacists can use this or other plan comparison platforms to help patients compare and select cost-effective Medicare Part D prescription plans. By linking data from the pharmacy dispensing software to the plan comparison platform, the pharmacist was able to help the patient compare plans easily and more efficiently. The cost savings from using the platform slightly exceeded the estimated cost savings stated by iMedicare. Patients were most concerned about selecting a plan with low annual deductibles; however, the majority of cost savings resulted from a decrease in average monthly copayments. Patients who participated in the open enrollment service were able to select new plans that resulted in cost savings. Community pharmacists are conveniently positioned to help Medicare beneficiaries in the often confusing process of Part D plan selection. We should determine specific patient considerations, such as deductible or pharmacy inclusion, when aiding a patient in selecting a medication plan that is best for them.
Acknowledgments The authors thank Audrey Cohenour Newton, PharmD, for support, assistance in data collection, and project oversight and David Lee, PharmD, PhD, for mentorship and oversight during the publication process.
References 1. Centers for Medicare and Medicaid Services. Medicare ProgrameGeneral Information. Available at: https://www.cms.gov/Medicare/MedicareGeneral-Information/MedicareGenInfo/index.html. Accessed September 9, 2015. 2. Madden JM, Graves AJ, Ross-Degnan D, Briesacher BA, Soumerai SB. Costrelated Medication nonadherence after implementation of Medicare Part D, 2006-2007. JAMA. 2009;302(16):1755e1756. 3. Kaiser Family Foundation. The Medicare Prescription Drug Benefit Fact Sheet. Available at: http://kff.org/medicare/fact-sheet/the-medicareprescription-drug-benefit-fact-sheet/. Accessed September 9, 2015. 4. Centers for Medicare and Medicaid Services. Getting started with Medicare. Available at: www.medicare.gov. Accessed September 16, 2015. 5. Thatcher E, VanWert E, Erickson S. Potential impact of pharmacist interventions to reduce cost for Medicare Part D benificiaries. J Pharm Pract. 2012;26(3):248e252. 6. iMedicare. About us. Available at: https://imedicare.com/#/about. Accessed September 2, 2015. 7. iMedicare. Benefits. Available at: https://imedicare.com/#/benefits. Accessed September 2, 2015. 8. Martino SC, Kanouse DE, Miranda DJ, Elliott MN. Can a more user-friendly Medicare plan finder improve consumers’ selection of Medicare plans? Health Serv Res. 2016 [Epub ahead of print]. Available at: http://dx.doi. org/10.1111/1475-6773.12582. Accessed December 14, 2016. Chelsea E. Leonard, PharmD, Director of Clinical Services, Chad’s Payless Pharmacy, Florence, AL Frances V. Cohenour, PharmD, Owner and Pharmacist in Charge, Chad’s Payless Pharmacy, Florence, AL Lindsey A. DeLoach, PharmD, Specialty Pharmacy Services, University of AlabamaeBirmingham Medical Center, Birmingham, AL John A. Galdo, PharmD, BCPS, BCGP, Assistant Professor and Community Practice Residency Director, McWhorter School of Pharmacy, Samford University, Birmingham, AL
Contents lists available at ScienceDirect
Journal of the American Pharmacists Association journal homepage: www.japha.org
RESEARCH
Impact of an open enrollment service on costs for Medicare Part D beneficiaries Chelsea E. Leonard*, Frances V. Cohenour, Lindsey A. DeLoach, John A. Galdo a r t i c l e i n f o
a b s t r a c t
Article history: Received 1 September 2016 Accepted 13 March 2017
Objective: The primary objective was to determine total estimated cost savings based on a patient’s current medication regimen after comparing available Medicare Part D plans for the upcoming year by using a plan comparison platform. The secondary objective was to determine patient-centered concerns when considering a change in Part D plans. Design: Review of an open enrollment service that included a patient survey and a Part D plan comparison. Setting: This study took place at a single independent community pharmacy in northwest Alabama. Participants: Fifty-four patients eligible for Medicare Part D were included in this study. Main outcome measures: The study was a review of an open enrollment service that aids Medicare beneficiaries in selecting a Part D plan that best fits their needs. It included a patient survey and plan comparison using a plan comparison platform, during the 2015 Medicare open enrollment period (October 15 to December 7). The survey assessed patient demographics, pharmacy preferences, and cost concerns. Survey data were used to aid in plan selection and analysis to determine the most common patient-centered concerns when considering a change in plans. Results: During the open enrollment period, 54 patients compared Medicare Part D plans. The majority of participants were female (57%) and ranged in age from 65-69 years (37%) to 70-74 years (25.9%). The majority of patients reported a preference for independent pharmacies (92.6%). Deductible (40.7%) was the biggest concern for patients when comparing the main cost variables for medication insurance. The average total cost difference per patient per year showed that each patient saved an average of $1166.46. Conclusion: The analysis of an independent pharmacy’s open enrollment service determined that a plan comparison platform is a valuable tool in helping patients to compare and select cost-effective Medicare Part D prescription plans and in helping patients save money. © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.
Medicare is a federal health insurance program for patients age 65 years and older, patients younger than 65 years with certain disabilities, and all patients with end-stage renal disease.1 The Medicare Modernization Act of 2003 established a voluntary prescription drug benefit plan for patients on Medicare, known as Part D. Medicare Part D took effect in 2006, and all patients on Medicare have the option to enroll in a private plan that has been approved by the federal government. Disclosure: The authors declare no conflicts of interest or financial interests in any product or service mentioned in this article. Funding: Project funded in kind by Chad’s Payless Pharmacy, Inc. Previous presentation: Poster presentation at American Pharmacists Association (APhA) annual meeting held in Baltimore, MD, March 5, 2016. * Correspondence: Chelsea E. Leonard, PharmD, Director of Clinical Services, Chad’s Payless Pharmacy, 501 W College Street, Florence, AL 35630. E-mail address: [email protected] (C.E. Leonard).
Patients enrolled in a Medicare Part D plan are more likely to be adherent to their long-term medications than Medicare beneficiaries without drug coverage; this is thought to be due to lower costs for prescription medications.2 In 2016, more than 41 million Medicare beneficiaries were enrolled in a Part D plan, and there were 24 plans available to Medicare beneficiaries in Alabama.3 Open enrollment for patients to choose a Part D plan or change their current plan occurs each year from October 15 to December 7, and patients who are turning 65 are eligible for enrollment 3 months before their 65th birthday, the entire month of their birthday, and the following 3 months.4 Each Medicare Part D plan has a different formulary, monthly premium, copayment, and annual deductible.5 The Centers for Medicare and Medicaid Services currently has a Medicare Plan Finder feature on the website that allows patients to enter their information and medication list and compare plan options.
http://dx.doi.org/10.1016/j.japh.2017.03.005 1544-3191/© 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.
SCIENCE AND PRACTICE C.E. Leonard et al. / Journal of the American Pharmacists Association 57 (2017) S225eS228
Key Points Background: Medicare Part D is an optional prescription drug program for those eligible for Medicare. Each Part D plan has a different formulary, monthly premium, annual deductible, etc. Studies have demonstrated that patients with a Medicare Part D plan are more adherent–likely due to lower costs of medications. Determining which plan to choose can be a confusing and difficult process for patients and caregivers. There are several proprietary software platforms that simplify the Part D plan comparison process.
pharmacist using a comparison tool could replicate the stated benefits. The most recent publication is from the RAND Corporation; it suggests a need for a more user-friendly version of the Medicare Plan Finder.8 Therefore, the purpose of this study was to evaluate an open enrollment service consisting of a survey and plan comparison to substantiate the reported benefits and effectiveness of a plan comparison platform (iMedicare) on costs for Medicare Part D beneficiaries. Objectives The primary objective was to determine total estimated cost savings based on a patient’s current medication regimen after comparing available Medicare Part D plans for the upcoming year by using the plan comparison platform. The secondary objective was to determine patient-centered concerns when considering a change in Part D plans.
Findings:
Methods
The majority of patients who participated in the open enrollment service indicated that the annual deductible was the most concerning factor. Average cost savings for 54 patients who participated in the Open Enrollment service was $1166.46 for 2016. Plan comparison platforms are useful tools for helping patients determine which Part D plan to choose. Patient-centered concerns should be considered when helping a patient select a Part D plan.
Setting
Community pharmacies may not be in-network or preferred for all available plans. Several proprietary companies have developed interfaces to the Medicare Plan Finder to facilitate patient understanding. This project used one of these platforms offered in an independent community pharmacy to help patients compare Medicare Part D plans. iMedicare launched in 2012 in a single community pharmacy, and it has expanded to more than 4000 pharmacies in the United States.6 The software is similar to the plan finder on the Centers for Medicare and Medicaid Services website; however, the proprietary system syncs directly with the pharmacy dispensing software to allow the patient to see his or her current medication regimen based on the pharmacy dispensing record for each plan. This allows the pharmacist conducting the plan comparison to be more efficient and spend less time entering medications into the plan finder. The pharmacist also has the ability to deselect a medication if it has been discontinued or was a 1-time-only fill, such as an antibiotic. Some of the data available to the patient and pharmacist includes projected monthly and yearly costs, preferred pharmacy network (independent, community, mail order), and therapeutic alternatives on the selected formulary. iMedicare claims that patients who used their platform to compare insurance plans saved an average of $1150 per year.7 There are limited published data replicating the stated benefits of plan comparison programs. There is no peer-reviewed evidence supporting the use of iMedicare. Moreover, in the existing literature, no study examined whether a community
S226
The practice site is an independent community pharmacy in northwest Alabama. The pharmacy fills approximately 350 prescriptions per day and offers clinical services such as Medication Therapy Management; diabetes education classes accredited by the American Association of Diabetes Educators; routine and travel immunizations; and biometric health screenings, which include cholesterol, blood glucose, blood pressure, and body mass index assessment. Study design This review of an open enrollment service included a patient survey and Medicare Part D plan comparison using iMedicare during the 2015 Medicare open enrollment period (October 15 to December 7). The open enrollment service was offered to patients at an independent pharmacy in Florence, Alabama. Medicare beneficiaries who filled prescriptions at the pharmacy were identified through data reports generated by iMedicare and the pharmacy’s dispensing system. Patients identified from these reports were contacted by telephone, bag stuffers, and face-to-face queries about this free service. Interested patients made an appointment with a pharmacist to conduct a plan comparison using iMedicare. As part of the service, the pharmacist documented the projected costs if a patient remained on their current plan and their estimated costs if they elected to change to a different plan. Patients were also given a survey before the plan comparison that assessed patient demographics, pharmacy preferences, and cost concerns. The survey was developed by pharmacists and patients, and it underwent pilot testing by patients older than 65 years. Survey data were used to aid pharmacists and patients in plan selection, and they were later analyzed to determine the most common patient-centered concerns when considering a change in plans. For example, if a patient indicated that they wished to have a lower deductible, the pharmacist helped them look for plans with a low or no deductible. The pharmacist also took formulary restrictions (e.g., prior authorizations, step therapy, nonformulary medications) into consideration and discussed any potential restrictions with the
SCIENCE AND PRACTICE Impact of Part D plan differences on costs for beneficiaries
Table 1 Survey question results
$300.00
No. of respondents
Do you ever skip doses because of cost? Yes 3 (5.5%) No 51 (94.4%) What is your pharmacy preference? Independent 50 (92.6%) Chain 3 (5.5%) Mail order 1 (1.9%) What is your major concern regarding insurance cost? Deductible 22 (40.7%) Monthly premium 11 (20.3%) Monthly copayment 16 (29.6%) Other 5 (9.3%)
$250.00
Dollars
Survey question
$350.00
$200.00 $150.00 $100.00 $50.00 $-
DeducƟble (Yearly Average)
Premium (Monthly Average)
Co-Payment (Monthly Average)
Before
$305.56
$40.42
$204.02
AŌer
$191.11
$28.64
$122.96
Savings
$114.45
$11.78
$81.06
Key: Number of parƟcipants 54.
Results are patient reported and may not add to 100% because of rounding.
Figure 1. Impact of plan differences.
patients. Plan comparisons were conducted only with a pharmacist. Patients were given the option to remain on their current plan, switch plans at the time of comparison, or switch plans at the pharmacy at a later date after they had time to consider all of their options. Patients were included in the analysis if they participated in the Chad’s Payless Pharmacy Open Enrollment service during Medicare’s Open Enrollment period. There were no patients excluded that participated in the service.
(92.6%). Deductible (40.7%) was the biggest concern for patients when comparing the main cost variables for medication insurance. The patients who selected “other” as their primary concern either wanted to ensure the pharmacy was in the plan’s preferred network or simply wanted the plan that was the least expensive overall. When specific concerns were raised by the patient, the pharmacist discussed those concerns and helped them to select a plan that best aligned with the patient-centered outcome. Figures 1 and 2 show the cost analysis results of the study. Figure 1 shows the average difference in cost of the deductible, premium, and copayment for the participants before plan comparison, after plan comparison, and the average savings. On average, patients had a decrease in cost of $114.44 for the yearly deductible, $11.78 for the monthly premium, and $81.05 for monthly copayments. iMedicare calculates the estimated total yearly costs based on the monthly premiums and average monthly copayments with the deductible factored into the total cost. The total maximum amount saved by any patient was $6866, with the least amount saved by any patient being $20. Figure 2 is the average total cost difference per patient per year, which shows each patient saved an average of $1166.46 per year; this is $16.46 more than the $1150 claimed by the plan comparison platform.
This project was approved by the Samford University Investigational Review Board. De-identified data, including demographic information, survey responses, and precomparison and postcomparison cost data, were provided from the pharmacy to researchers at Samford University. Descriptive statistics were used to evaluate the data. Results During the open enrollment service period, 54 patients compared Medicare Part D plans. When using the service, 49 patients switched to less-expensive plans. Three patients did not change plans because they were already on the best plan for them. Two patients switched to plans that were more expensive so that they could remain in a network in which the pharmacy was preferred. The majority of participants were female (57%) and ranged in age from 65-69 years (37%) to 70-74 years (26%); 18.5% of patients were younger than 65 years, 11.1% were 75-79 years old, 5.5% were 80-84 years old, and 1.9% were older than 85 years. Only 12 patients (22.2%) were considered dual eligible. Dualeligible patients have Medicare and are eligible for some form of Medicaid benefit. Frequently, the Medicaid benefit will cover the Medicare monthly premiums, or the patient will qualify for Medicare Extra Help paying for prescription drugs, or both. Table 1 provides a summary of the survey responses obtained from patients during the open enrollment program. The aim of this survey was to determine patient-centered concerns when contemplating a change in Medicare Part D plans. A patient-centered outcome is one that addresses factors that are of importance to a patient. The survey focused on trying to identify those various factors for each patient. Only 3 patients (5.5%) reported skipping a dose because of cost, and most indicated a preference for independent pharmacy
Discussion We studied an open enrollment service that assessed cost savings for Part D beneficiaries during the 2015 Medicare open enrollment period. This research shows that patients are concerned about the cost of their annual deductible. $4,000.00 $3,500.00 $3,000.00
Dollars
Analysis
$2,500.00 $2,000.00 $1,500.00 $1,000.00 $500.00 $Average Total Cost to PaƟent per Year
Before
AŌer
Savings
$3,555.65
$2,389.20
$1,166.45
Key: Number of parƟcipants is 54. Figure 2. Average total cost to patients per year.
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SCIENCE AND PRACTICE C.E. Leonard et al. / Journal of the American Pharmacists Association 57 (2017) S225eS228
Approximately 40% of patients cited deductibles as the main cost concern when comparing insurance plans; however, the majority of cost savings emerged from reductions in monthly copayments ($114.44 average yearly reduction in deductible versus $972.60 average yearly reduction in copayments). The advent of the Patient Protection and Affordable Care Act of 2010 has caused numerous changes to the health care system. One of the benefits is the move toward patientcentered care. Community pharmacists have a role in empowering patients by helping them to understand differences between the available insurance plans. Despite numerous reports of high-cost prescriptions plans, the results from this study show that less costly options for medication insurance plans often exist for patients. Community pharmacies are often innovating practice through nondispensing services, yet few data exist to support the impact of these services. This study helps to substantiate services focused on aiding patients in selecting the best Medicare Part D insurance plan for their needs. The study found nearly identical cost savings per patient compared with the publicized amount. Community pharmacists are at the forefront of the health care field. As the United States population continues to age, more individuals are going to enroll in Part D plans, and community pharmacists are poised to provide assistance in this arena. Proprietary companies provide services that interconnect the Medicare Plan Finder and dispensing software, saving the pharmacist and the patient time and money. This research starts the literature validating the impact of these services. Further research should be conducted with larger sample sizes, different practice settings and different geographical locations, and between proprietary software offerings. Limitations This project has several limitations. Data collection occurred in a single independent pharmacy in northwest Alabama; further analysis is warranted within a large network. In addition, only 54 patients participated in the pharmacy’s open enrollment program, which is a small number of patients compared to the estimated number of eligible patients in the area and in the pharmacy. Another limitation is the concern of the pharmacy being preferred or in-network. For patients who wanted to stay with this independent pharmacy, the pharmacist discussed preferred and in-network status with the patients. Considering that pharmacys' status, formularies, deductibles, copayments, and existing plans change each year, it is necessary to repeat this service offering annually. Future research could include investigating whether the patient participated in a plan that offered medication therapy management services or vaccinations. Other avenues of investigation could include researching only dual-eligible patients or only patients interested in Medicare Advantage plans, which administer the benefits of Parts A, B, and D. Finally, research comparing insurance plan comparison platforms should be conducted to evaluate the differences among various platforms. Community pharmacists are often requested to purchase or use various platforms, such as iMedicare, to aid in the Part D plan selection; however, no literature exists comparing these platforms to help pharmacists select a tool that will be helpful for them and their patients.
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Conclusion iMedicare was found to be a valuable tool for the open enrollment service at Chad’s Payless Pharmacy. Pharmacists can use this or other plan comparison platforms to help patients compare and select cost-effective Medicare Part D prescription plans. By linking data from the pharmacy dispensing software to the plan comparison platform, the pharmacist was able to help the patient compare plans easily and more efficiently. The cost savings from using the platform slightly exceeded the estimated cost savings stated by iMedicare. Patients were most concerned about selecting a plan with low annual deductibles; however, the majority of cost savings resulted from a decrease in average monthly copayments. Patients who participated in the open enrollment service were able to select new plans that resulted in cost savings. Community pharmacists are conveniently positioned to help Medicare beneficiaries in the often confusing process of Part D plan selection. We should determine specific patient considerations, such as deductible or pharmacy inclusion, when aiding a patient in selecting a medication plan that is best for them.
Acknowledgments The authors thank Audrey Cohenour Newton, PharmD, for support, assistance in data collection, and project oversight and David Lee, PharmD, PhD, for mentorship and oversight during the publication process.
References 1. Centers for Medicare and Medicaid Services. Medicare ProgrameGeneral Information. Available at: https://www.cms.gov/Medicare/MedicareGeneral-Information/MedicareGenInfo/index.html. Accessed September 9, 2015. 2. Madden JM, Graves AJ, Ross-Degnan D, Briesacher BA, Soumerai SB. Costrelated Medication nonadherence after implementation of Medicare Part D, 2006-2007. JAMA. 2009;302(16):1755e1756. 3. Kaiser Family Foundation. The Medicare Prescription Drug Benefit Fact Sheet. Available at: http://kff.org/medicare/fact-sheet/the-medicareprescription-drug-benefit-fact-sheet/. Accessed September 9, 2015. 4. Centers for Medicare and Medicaid Services. Getting started with Medicare. Available at: www.medicare.gov. Accessed September 16, 2015. 5. Thatcher E, VanWert E, Erickson S. Potential impact of pharmacist interventions to reduce cost for Medicare Part D benificiaries. J Pharm Pract. 2012;26(3):248e252. 6. iMedicare. About us. Available at: https://imedicare.com/#/about. Accessed September 2, 2015. 7. iMedicare. Benefits. Available at: https://imedicare.com/#/benefits. Accessed September 2, 2015. 8. Martino SC, Kanouse DE, Miranda DJ, Elliott MN. Can a more user-friendly Medicare plan finder improve consumers’ selection of Medicare plans? Health Serv Res. 2016 [Epub ahead of print]. Available at: http://dx.doi. org/10.1111/1475-6773.12582. Accessed December 14, 2016. Chelsea E. Leonard, PharmD, Director of Clinical Services, Chad’s Payless Pharmacy, Florence, AL Frances V. Cohenour, PharmD, Owner and Pharmacist in Charge, Chad’s Payless Pharmacy, Florence, AL Lindsey A. DeLoach, PharmD, Specialty Pharmacy Services, University of AlabamaeBirmingham Medical Center, Birmingham, AL John A. Galdo, PharmD, BCPS, BCGP, Assistant Professor and Community Practice Residency Director, McWhorter School of Pharmacy, Samford University, Birmingham, AL