One vital tool that we recommend every agent become familiar with is our new Drug Cost Estimator within the Ritter Platform. Knowing the tool exists is one thing, but making it work for you and your clients is another.
To understand how the Drug Cost Estimator works and how to make more informed plan recommendations for your clients, it’s important to know what makes a good prescription drug plan (PDP). The key consideration is this: Will it cover your client’s drugs at an affordable cost? A low-cost plan premium with a preferred pharmacy right next door sounds sweet until you learn the most expensive medication your client takes isn’t covered by the plan’s formulary.
How can you make sure you’re enrolling clients in an affordable prescription drug plan? Follow the four simple steps below.
1. Collect and Review Your Client’s Prescription Drug Info
Before or during your meeting with a client, you should collect a complete list of the prescription drugs they’re currently taking. It’s important to gather some specifics, including the name of the drug, the dosage, the frequency it needs taken, how often the client refills it, their preferred retail pharmacy, and if they’d like prescriptions delivered by mail.
Tip: If your client is taking one or more name-brand drugs, ask if they would consider taking a generic version to help lower costs.
Getting the specifics right is particularly essential since that’s how a PDP’s formulary will be organized. If your client doesn’t know these figures off the top of their head, they can generally find them by checking their prescription labels.
2. Enter Your Client’s Prescription Drugs into a Shop & Enroll Account
To help you keep track of your client’s prescription list, we suggest securing your own Shop & Enroll site and inviting your clients to create their own Shop & Enroll accounts. These Shop & Enroll accounts securely store clients’ personal data, which includes prescription drug information. The records are updated in real-time and shared between you and client, so both of you can make updates to the information as necessary.
The information entered into each client’s Shop & Enroll account is available within the Clients tab in the Ritter Platform, which acts as a customer relationship management (CRM) system. From the Clients tab, the Drug Cost Estimator can be accessed and the client’s info will be prepopulated into the quoting system.
3. Use the Drug Cost Estimator to Compare the Available PDP Options with Your Client
PDPs vary in a few key areas, and we mean it when we say there’s no such thing as “the best PDP” for any state or region. Every plan recommendation should depend on the specific needs of your client, so it’s important for you to consider all the variables when comparing plans.
The Drug Cost Estimator is an essential tool for you to use when comparing PDP plans because a client’s personal data is pulled and used to run the estimates. You’re able to make a plan recommendation based on more specific factors that are unique to each client.
Here is a look at how the Drug Cost Estimator works!
Additionally, there are three major factors that determine the quality of a PDP are its formulary, its premium and deductible costs, and its network of pharmacies.
Formularies
Carriers define what drugs they’ll pay for by placing every drug into tiered formularies. Typically, the most expensive drugs are placed in higher tiers where the member is responsible for most of the cost, while lower-cost, generic drugs are placed in the first tier. In our opinion, a plan’s formulary is the single biggest factor in how affordable and sensible a drug plan really is for a client.
Here’s a breakdown of a common five-tier formulary published by PlanPrescriber.com.
- Tier 1: Preferred generic drugs, lowest cost-sharing
- Tier 2: Non-preferred generic drugs
- Tier 3: Preferred brand-name drugs
- Tier 4: Non-preferred brand-name drugs
- Tier 5: Specialty drugs, highest cost-sharing
Premiums and Deductibles
Monthly premiums for PDPs vary by state or region depending on the carrier offering the plan. Likewise, deductibles vary by carrier and by plan. Some plans have a $0 deductible on all tiers, while others have a $0 deductible only on plan select tiers. Also worth mentioning, some plans have a maximum deductible allowed by CMS on all tiers, $445 for 2021 for example, and sometimes those plans can end up being lowest overall cost for a client.
It may be hard to break a client’s “lowest-premium-wins” perspective, but it’s important to consider if they can truly afford the plan with the cheapest premium. It may not be a good fit for clients who don’t have the means to pay the deductible up front.
Networks
Similar to how health plans have hospital networks, PDPs have pharmacy networks that provide drugs at a reduced cost. If your clients have a local pharmacy they trust, you’ll want to consider PDPs that include it as an in-network — or even better, a preferred — pharmacy. Here’s why.
- In-network — Members can use their plan benefits at these pharmacies in the broad network established by the plan.
- Preferred — Members may receive even lower copay or coinsurance benefits for covered drugs at these pharmacies than at standard in-network pharmacies.
- Out-of-network — Members don’t have any benefit coverage at these pharmacies that aren’t in a plan or carrier’s network.
4. Recommend a Plan from Your Diverse Portfolio
You’ve made it this far, and clearly, you have a knack for PDP sales. After you’ve gathered your client’s prescription drugs, run plan comparisons using the Drug Cost Estimator, and reviewed their available plan options, it’s time to do what you do best — make a recommendation and complete the sale!
If you have four different clients who each need a PDP, it’s completely possible that the proper recommendation could be a different plan for each. All it takes is a different location, fixed income, or prescription drug to drastically influence how a PDP fits a beneficiary. With that in mind, we suggest contracting to sell every available plan in your market or at the very least, performing regular portfolio reviews.
With the tips in this article and use of our tools like Shop & Enroll and the Drug Cost Estimator, you’ll be prepared to go out and close PDP sales. It’s important to note that you only gain access to our tools and resources by registering with us. It’s free and easy, with nothing to lose and so much to gain. So, complete your registration with Ritter and succeed in the PDP market!
Editor’s Note: This article was originally published in November 2018. It has been updated to include more relevant information.
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