When we generate Win Wins, we usually recommend plans that are the same plan type as the current plan that the patient is on. However, if we determine that the patient can save money by switching to a Medicare Advantage plan while increasing pharmacy profits, we take a few extra steps to make sure the plan is a good fit for the patient.
We only recommend a MA plan change if the pharmacy is located in a large metropolitan area (based on county code data). This means that it is more likely that their doctor is in-network and the plan is a good fit.
If the patient does not have any drugs in their active drug list with certain ATC/class_codes (such as L04AA).
If the patient does not have any drugs in their active drug list with certain clinical categories (such as auto-immune).
If the patient has all of their doctors in-network with the plan (based on the prescribing NPI and using our Dr. Lookup tool).
If you have questions about Medicare Advantage, our team is here to help. We have also partnered with HelathPlanOne (an insurance agency) who can help patients with Medicare Advantage and Medicare Supplement questions while you continue to help with PDPs. Learn more about why we chose HPOne here.