While Amplicare helps make the objective assessment of in-network plans easier and as their trusted pharmacist you may provide the patient with access to the Amplicare website, it is important to remember that the patient must complete the online enrollment process into a Medicare plan. You may not complete the enrollment transaction on their behalf or steer the patient toward any particular plan or group of plans. Here are some “Dos and Don’ts” to remember: 

Overall

  • Pharmacists may engage in objective discussions with patients seeking advice about their plan options.
  • When discussing various plans with patients, the pharmacist must remain neutral during the patient decision process. "Neutral" means that the pharmacist presents only an objective assessment of the patient's needs and potential options to meet those needs without encouraging or suggesting the patient choose a particular plan. 
  • If a pharmacist is contracted with one or more plan sponsors, any assistance provided to a patient must always be in the best interest of the patient and never based on financial or any other interests of the provider. 

Permitted 

When meeting with a patient as part of the professional relationship between the pharmacist and the patient, and not directed by a plan or Part D sponsor, the pharmacist may: 

  • Distribute unaltered, printed materials created by CMS; 
  • Provide the names of plans/Part D sponsors with which the pharmacist is contracted and/or participates; 
  • Answer questions or discuss the merits of a plan or plans, including cost-sharing and benefits information; 
  • Refer patients to other sources of information; and 
  • Refer patients to marketing materials available in common areas. 

In the common areas of the pharmacy (defined below), pharmacists may: 

  • Provide or make available plan marketing materials and enrollment forms in common areas of the pharmacy. "Common areas" include the space outside of where the patients interact with pharmacy providers and obtain medications, such as common entryways and community or conference rooms. 
  • Make available and/or distribute printed information prepared by an objective third party (such as Amplicare), which compares the benefits of different plans in the pharmacy's service area. 

Additionally, pharmacies may announce a new or continuing plan affiliation once a contractual agreement with the Part D sponsor or plan has been approved. The announcement must: (1) clearly state that the pharmacist may also contract with other plans or sponsors, if applicable; and (2) be made through direct mail, email, and telephone. The announcement cannot include plan benefits, premiums, or cost sharing information without prior approval from CMS. 

Not Permitted 

Pharmacists may not, in any setting or instance: 

  • Direct, urge, steer, or attempt to persuade patients to enroll in a particular plan based on financial or any other interests of the provider; 
  • Fill out and/or submit an enrollment application on behalf of a patient without legal authority to do so (such as power of attorney); 
  • Offer any kind of an inducement (financial or other) to persuade a patient to enroll in a particular plan or to select the pharmacist as their provider; 
  • Make available or distribute plan marketing materials or enrollment forms in areas where the patients interact with pharmacy providers or pick up their medications; 
  • Accept any compensation from a plan for marketing or enrollment activities; 
  • Mail marketing materials on behalf of plan sponsors; or 
  • Accept any type of Medicare enrollment applications.
  • Don't use words like "Best" -- that's up to the patient to decide. Instead, you can point out objective facts, such as "This plan is cheapest" and "This plan has no restrictions". 

DO

  • Do show multiple plan options to the patient. Patients need to make the decision themselves, so you need to show several options and let them decide what's right for them. Use the Patient View when reviewing plans with patients.
  • Do explain that plan formularies change each year. It's important that patients understand the plan they like this year may change drastically next year. Plus, this encourages them to come back for plan comparisons every year!
  • Do print out a plan comparison summary for the patient to take home with them to refer to. This way the patient has it to refer to if they ever have any questions. Do this by selecting the plans they are considering, clicking "Compare Plans", and then "Print Preview".  There is also an option to email the plan comparison directly from the "Print Preview" page if you prefer.  
  • Do help the patient understand their of out-of-pocket cost throughout the year and restrictions associated with each plan.
  • For patients who have never enrolled in Medicare before, DO engage them in a conversation rather than just sending them a letter or stapling a printed handout to their prescription bag. Help these patients understand what it means to be eligible for Medicare, and let them know how YOU can help them choose a plan that will work for them! Brokers will begin reaching out to patients as soon as they are eligible for Medicare, so this is your opportunity to get to them first! Starting the conversation will show your patients that you care, and this can help build trust in your pharmacy. Send them a voice message using this script, or take a look at the best practices for getting these patients into the pharmacy for a plan comparison! 

What's Next?

Learn more about how to have an effective plan comparison consultation with your patients!

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