One vital tool that we recommend every agent become familiar with is the prescription drug search feature inside the Medicare Plan Finder on Medicare.gov. Knowing the tool exists is one thing, but making it work for you and your clients is another.
To understand how Medicare.gov’s prescription drug search works and how to make more informed plan recommendations for your clients, it’s important to know what makes a good prescription drug plan (PDP). The key consideration is this: Will it cover your client’s drugs at an affordable cost? A $0-premium plan with a preferred pharmacy right next door sounds sweet until you learn the most expensive medication your client takes isn’t covered by the plan’s formulary.
How can you make sure you’re enrolling clients in an affordable prescription drug plan? Follow the four simple steps below.
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1. Collect a List of Your Client’s Prescription Drugs
Before or during your meeting with a client, you should collect a complete list of the prescription drugs they’re currently taking. It’s important to gather some specifics, including the name of the drug, the dosage, the frequency it needs taken, how often the client refills it, their preferred retail pharmacy, and if they’d like prescriptions delivered by mail. Getting the specifics right is particularly essential since that’s how a PDP’s formulary will be organized. If your client doesn’t know these figures off the top of their head, they can generally find them by checking their prescription labels.
We know that’s a lot of information to gather. To help you keep everything in order, we’ve created a convenient Prescription Drug Collection Form. You can download it using the link below!
2. Enter Your Client’s Prescription Drugs into Medicare.gov’s Tool
Now it’s time to make the most of everything you’ve learned about your client. While most agents may know about Medicare.gov’s prescription drug search tool, many don’t understand how to best use it. That’s where the Agent Survival Guide comes in. With the help of Ritter’s PDP Specialist, we created this brief video overview to give you a hands-on lesson on using Medicare.gov’s prescription drug search feature. Watch it here.
3. Compare the Available PDP Options with Your Client
PDPs vary in a few key areas, and we mean it when we say there’s no such thing as “the best PDP” for any state or region. Every plan recommendation should depend on the specific needs of your client, so it’s important for you to consider all the variables when comparing plans. The three major factors that determine the quality of a PDP are its formulary, its premium and deductible costs, and its network of pharmacies.
Carriers define what drugs they’ll pay for by placing every drug into tiered formularies. Typically, the most expensive drugs are placed in higher tiers where the member is responsible for most of the cost, while lower-cost, generic drugs are placed in the first tier. In our opinion, a plan’s formulary is the single biggest factor in how affordable and sensible a drug plan really is for a client.
Here’s a breakdown of a common five-tier formulary published by PlanPrescriber.com.
- Tier 1: Preferred generic drugs, lowest cost-sharing
- Tier 2: Non-preferred generic drugs
- Tier 3: Preferred brand-name drugs
- Tier 4: Non-preferred brand-name drugs
- Tier 5: Specialty drugs, highest cost-sharing
Premiums and Deductibles
Monthly premiums for PDPs vary by state or region depending on the carrier offering the plan. Likewise, deductibles vary by carrier and by plan. Some plans have a $0 deductible on all tiers, while others have a $0 deductible on some, but not all, plan tiers.
It may be hard to break a client’s “lowest-premium-wins” perspective, but it’s important to consider if they can truly afford the plan with the cheapest premium. It may not be a good fit for clients who don’t have the means to pay the deductible up front.
Similar to how health plans have hospital networks, PDPs have pharmacy networks that provide drugs at a reduced cost. If your clients have a local pharmacy they trust, you’ll want to consider PDPs that include it as an in-network — or even better, a preferred — pharmacy. Here’s why.
- In-network — Members can use their plan benefits at these pharmacies in the broad network established by the plan.
- Preferred — Members may receive even lower copay or coinsurance benefits for covered drugs at these pharmacies than at standard in-network pharmacies.
- Out-of-network — Members don’t have any benefit coverage at these pharmacies that aren’t in a plan or carrier’s network.
4. Recommend a Plan from Your Diverse Portfolio
You’ve made it this far, and clearly, you have a knack for PDP sales. After you’ve gathered your client’s prescription drugs, input them into Medicare.gov, and compared their available plan options, it’s time to do what you do best — make a recommendation and complete the sale!
If you have four different clients who each need a PDP, it’s completely possible that the proper recommendation could be a different plan for each. All it takes is a different location, fixed income, or prescription drug to drastically influence how a PDP fits a beneficiary. With that in mind, we suggest contracting to sell every available plan in your market.
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Ritter Insurance Marketing contracts with leading Part D carriers and gets to know the ins and outs of every plan, and how competitive they are, across the nation. If you’re looking for insight on what PDPs you should have in your portfolio, Ritter can get you connected and ready to sell. Reach out to your account specialist and get the lowdown on the plans in your area.