STEP 1: Log in at app.amplicare.com

Tip: Bookmark this page on your computer workstations for easy access.

STEP 2: Search for the patient and go to their "Medicare Plans" tab

STEP 3: Enter or confirm your patient’s current plan and subsidy information. 

Learn more about how to check current plan or subsidy. 

STEP 4: Confirm your patient’s active drug list is up-to-date

  • Manually add maintenance medications that they're filling at another pharmacy.
  • Deactivate one-time use medications (most one-time use medications are automatically deactivated). 
  • Click on any of the medications to edit their day supply and/or quantity if needed.

STEP 5: Select the appropriate plan types to include in the comparison 

By default the plan type selected will match the patient's current plan type entered in their Amplicare profile. We recommend keeping the patient in the same plan type as their current plan unless the patient explicitly states otherwise. 

Learn more about the different plan types.

STEP 6: Adjust the sorting and filtering options


Show:
"All Plans" or "Preferred Plans" -- We recommend keeping "All Plans" selected, which will show you all plans that are in-network with your pharmacy and available in your patient's zip code. There's a misconception that preferred plans will be the cheapest plan option for your patient to fill at your pharmacy, but oftentimes that's not actually not the case. Learn more about preferred plans. 

Sort: "Out-of-Pocket", "Annual Deductible", "Monthly Premium", "CMS Star Ratings", "Est. DIR Fees", and "Est. Revenue" -- Sort the plans based on your patient's preferences. By default the plans will be sorted by "out-of-pocket", which is a total of the patient's copays and monthly premiums.

Effective: {{month}} -- this will specify the month when the patient's new plan coverage will go into effect once they enroll in the plan. 

Nearby Pharmacy: Leave this option as is. By default all plan pricing reflects what the patient would pay if they fill at your pharmacy. Learn more about when to use the Nearby Pharmacy tool.

STEP 7: Review the information for each of the resulting plans

  1. Plan name and plan's CMS star rating. Hover your mouse over "Info" to see a tooltip including the plan's CMS contract and plan ID, as well as BIN, PCN, and Group numbers.
  2. Monthly premium (what the patient will pay directly to the plan each month as a flat fee) and annual deductible (traditionally what the patient will have to pay for their medications out-of-pocket before the plan begins to cover a portion of their costs). 
  3. Out-of-pocket cost. This number reflects the total amount the patient is projected to pay out-of-pocket (monthly premiums and copays for medications). 
  4. Plan tags indicate important information about the plan's preferred network and coverage. Learn more about what each of these tags mean ("Preferred", "Non-Preferred", "Mail Order", "Chain", "Benchmark", and "Gap Coverage"). 
  5. Drug restrictions indicate if there will be any restrictions for any of the patient's active medications with that plan. Click the link to see a dropdown with specific information.  Learn more about plan formulary restrictions. 
  6. Est. DIR Fee and Est. Revenue: Hover your mouse over these numbers to see a tooltip with more information. Learn more about considering DIR fees while doing a plan comparison. 

Tip: If you're working directly with a patient we recommend switching to "Patient View" to hide irrelevant information for them (i.e. estimated revenue and DIR fees). Learn more about "Patient View" vs. "Pharmacy View".  
 

STEP 8: Select multiple plans to compare a breakdown in out-of-pocket costs

Select the plans in which the patient would like to see a further breakdown in costs by clicking the little box on the bottom left of each plan. Then, click COMPARE PLANS on the lower right of the screen.

We recommend selecting at least two other plans in addition to the patient's current plan to compare side-by-side.

Step 9: Compare the breakdown in costs on the Monthly Cost page

  • Click the name of a month, and it will expand to show the specific medications the patient will fill that month. Under the "Copay" column you'll see what their associated copay will be. Under "Full cost" you'll see what the full cost of the medication is (a sum of the patient's copay and the insurance reimbursement). Note: The "Full cost" column will be hidden in "Patient View". 
  • This page will also clearly show how the patient transitions through different phases of coverage (Initial Coverage, Donut Hole, Catastrophic Coverage). Learn more about how to discuss the Medicare phases of coverage with your patients.

Note: If your patient is interested in comparing Medicare Advantage (MA-PD) plans, there are more factors to consider. 

STEP 10: Help your patient enroll

After reviewing the information on the Monthly Cost page, your patients can decide to enroll in a new plan. Learn more about the options to help them do this!

What's Next?

Learn more about best practices for consulting with your patients about Medicare plans.

Did this answer your question?