When helping a patient review their plan options with Amplicare, you can see and compare the estimated reimbursements and DIR fees for each plan. Full transparency is key to being prepared and maximizing your pharmacy's revenue!
Go to the "Medicare" tab in a patient's profile to view the list of available plan options. The estimated revenue and DIR fees are listed on each plan:
The Estimated Revenue is the insurance plan's gross reimbursement plus patient copays for a patient's active drug list subtracting estimated DIR fees. You can view the estimated revenue excluding DIR fees by hovering your mouse over the Est. Revenue value.
If you hover your mouse over the estimated DIR you can see the actual formula of the fee, what the fee is based on (i.e. store performance measurements), and whether the fee is percentage-based or a flat amount. We estimate the DIR fees conservatively by using the largest number if there's a range listed. Learn more about DIR Fees here.
Be sure you're in "Pharmacy View" and not "Patient View" in order to see the estimated revenue and DIR fees. The "view" toggle is on the upper right of the page:
You can Sort Plans by Est. Revenue or DIR Fees to better gauge the plans that will reimburse your pharmacy better.
You can also view the estimated reimbursement for each individual drug.
Select plans to "Compare". This will take you to the Monthly Breakdown page. From here, click on a month. It will expand and show you every medication the patient will fill that month, along with the full cost of each drug (reimbursement + copay) and patient copay.
Click on a specific drug, and you'll access a more detailed breakdown of the medication (tier, ingredient cost, and dispensing fee) for each plan:
If you need a refresher on how to perform a plan comparison, go here!