Medicare Part D A Managed Care Pharmacy Viewpoint

Medicare Part D: A Managed Care Pharmacy Viewpoint on Enrollment James R. Lang, Pharm. D, MBA Pharmacy Management Consultant Scheller Bradford Group 1

A Managed Care-Pharmacy Viewpoint On Enrollment n Industry Education Strategies and Expectations n Priorities for and Success Factors in the Enrollment Process n Perspectives on Coordinating Enrollment in Rural Communities 2

A Managed Care-Pharmacy Viewpoint on Enrollment Industry Education Strategies and Expectations n Medicare Rx Education Network n 40 national organizations n AHIP n NACDS n National Council on Aging n American Hospital Association n American Medical Association n AARP n BCBSA n Business Roundtable n Pharmaceutical Manufacturers 3

A Managed Care-Pharmacy Viewpoint on Enrollment Industry Education Strategies and Expectations n Educational Partnerships n n Humana / Wal-Mart Aetna / CVS / Rite Aid United Health Group / 24 page booklet distributed in many stores, Walgreen, CVS, Target Humana using ING to reach out and educate 4

A Managed Care-Pharmacy Viewpoint on Enrollment Industry Education Strategies and Expectations n Educational Partnerships n n n Coventry / Rite Aid community outreach, educational activities, and in-store experts Wellpoint / Walgreen in-store education and marketing, community outreach United Health / AARP using AARP publications, website, state offices, volunteers and community partners 5

A Managed Care-Pharmacy Viewpoint on Enrollment Industry Education Strategies and Expectations n Traditional Approach n n n Regence Group – educational seminars for current and potential members Care. First – Meetings and expos focused on seniors Aetna hosting educational workshops in 160 senior centers around the country, educational information is 2400 senior centers 6

A Managed Care-Pharmacy Viewpoint on Enrollment Industry Education Strategies and Expectations n Other Approaches n n n Ovations will use extensive information tools and consumer resources Epocrates – Educational website information Medicare Oklahoma – Medicare advocating education on Part D benefit with state-wide informal meetings 7

A Managed Care-Pharmacy Viewpoint on Enrollment Industry Education Strategies and Expectations n Pharmacies/pharmacists in a unique situation? n n Pharmacy is the most frequently used health benefit Thirty percent of consumers would likely turn to their pharmacist for help in deciding whether to enroll in a Medicare drug plan Reinforces the value of a strong retail network in a program Requires programs to have closer ties with pharmacies then claims payments 8

A Managed Care-Pharmacy Viewpoint on Enrollment Priorities and Success Factors in the Enrollment Process n Program / Partnership Strategies n Defend Turf / Grow Market-share n Expand Current Pharmacy Portfolio n New Competitors n Specialization 9

A Managed Care-Pharmacy Viewpoint on Enrollment Priorities and Success Factors in the Enrollment Process n Defend Turf / Grow Market-share n Blue Cross Blue Shield Programs n Large Commercial Health Plans n Medicare Advantage Plans n Medigap Plans Pros: Experience with individual sales, marketing, service, risk Cons: Varying degrees of true drug spend management 10

A Managed Care-Pharmacy Viewpoint on Enrollment Priorities and Success Factors in the Enrollment Process n Expand Current Pharmacy Portfolio n Chain Pharmacies n Independent Pharmacies n Pharmacy Benefit Managers Pros: PBMs have lots of experience with claims, customer service, formulary and clinical Cons: Little experience with individual sales, marketing, service, risk Little experience at true drug spend management beside volume discounts Pharmacies need partners 11

A Managed Care-Pharmacy Viewpoint on Enrollment Priorities and Success Factors in the Enrollment Process n New Competitors n Life Insurance Programs Pros: Experience with individual sales, marketing, service, risk Cons: No drug spend management capabilities n Specialization n HIV specialization 12

A Managed Care-Pharmacy Viewpoint on Enrollment Priorities and Success Factors in the Enrollment Process n Partnerships to reach and service members n Humana / ING n United Health Group (Ovations) / Walgreens n Universal American / Pharma. Care n Wellpoint / Walgreens n Pacifi. Care / AAA Auto Club South n Informed Decisions / NACDS to focus on the dual-eligible through Beneficiary Centered Enrollment program n NCPA / Member. Health / CSC 13

A Managed Care-Pharmacy Viewpoint on Enrollment Priorities and Success Factors in the Enrollment Process n Major enrollee behavior patterns unknown n n n Who will enroll? When will they enroll? Which enrollment channels will be most effective? What will be the distribution during initial signup period? How many will wait and see? Will it mimic DDC with many potential enrollees unaware of the program? Will the penalties scare enrollees into signing up? 14

A Managed Care-Pharmacy Viewpoint on Enrollment Priorities and Success Factors in the Enrollment Process n Basic Enrollment Presumptions n Sickest enrollees will seek benefit initially n Auto-enrollees / Dual-eligible will be assigned n Enrollees will migrate to known entities: § Blues § Local major health plan § Current DDC vendor § Pharmacist recommendation 15

A Managed Care-Pharmacy Viewpoint on Enrollment Priorities and Success Factors in the Enrollment Process n Importance of influencers: n Local pharmacist n Seniors groups n Peers n Family support structure n Senior center 16

A Managed Care-Pharmacy Viewpoint on Enrollment Priorities and Success Factors in the Enrollment Process n Auto-enrollees / Dual eligible n Will they stick? n Will they be marketed to? n Are they desirable? n Premium versus risk adjustor 17

A Managed Care-Pharmacy Viewpoint on Enrollment Priorities and Success Factors in the Enrollment Process n Success will depend on the member acquisition ease and cost n Experience in: n Individual marketing n Individual sales n Individual enrollment n Individual billing 18

A Managed Care-Pharmacy Viewpoint on Enrollment Priorities and Success Factors in the Enrollment Process n Enrollment n Paper Enrollment Forms n Face-to-face n Mail n FAX n Secure Internet Site n CMS On-line Enrollment Center n Telephone Enrollment (Only in- bound/recorded) n Auto-enrollment for Dual-Eligible 19

A Managed Care-Pharmacy Viewpoint on Enrollment Priorities and Success Factors in the Enrollment Process n Tremendous strain on resources leads to many solutions: n Redirecting staff n Enrollment period short and intense n Need to use experienced and knowledgeable staff n Complex program n During down time focus on those turning 65 n Outsource / Joint Venture 20

A Managed Care-Pharmacy Viewpoint on Enrollment Priorities and Success Factors in the Enrollment Process n PDP operational unknowns n Operational nightmares of the first 2 -3 months n Need highly trained personnel for a short duration n Unknown pattern, distribution, channel and timing n Auto-enrollees may need tremendous support 21

A Managed Care-Pharmacy Viewpoint on Enrollment Priorities and Success Factors in the Enrollment Process n Enrollment / Service Calls n Length of phone call n Number of phone calls n Internet penetration / savvy 22

A Managed Care-Pharmacy Viewpoint on Enrollment Priorities and Success Factors in the Enrollment Process n Satisfaction / growth dependent on good member service n Member service units do not staff for perfect: n Speed to answer stats n Talk time stats n First call resolution n Normal January / July timeframe is difficult at best 23

A Managed Care-Pharmacy Viewpoint on Enrollment Perspectives on Coordinating Enrollment Efforts in Rural Communities Independent pharmacy geographic distribution n Blues penetration n Major health plan penetration n 24

A Managed Care-Pharmacy Viewpoint on Enrollment n Necessary Elements (United Health) n Consumer friendly n Simple in design n Easy to use n Emphasis on consumer education n Affordability n Safety n Consumer choice 25