8 Powerful Practices for Selling Prescription Drug Plans

Everyone on Medicare needs creditable prescription drug coverage and most people don’t want a late enrollment penalty. If you’re offering Medicare Advantage-only plans (Private-Fee-For-Service) or Medicare Supplement plans, you can cross-sell prescription drug insurance.

Below, we outline a few best practices for selling PDPs!

Note: If your clients have MAPD plans but plan to enroll in stand-alone drug plans, make sure they know they’ll be disenrolled from their current plan and enrolled in Original Medicare (Part A and Part B).

Have your PDPs gone non-commissionable? See your options

1. Ask Your Clients for a List of Their Prescriptions Right Away

After having your clients sign a Scope of Appointment (SOA), one of the first things you should do is ask them for a list of their prescription drugs. Knowing what medications (especially high-cost prescription drugs) they take is imperative for finding them the right plan with the formulary that will cover their drugs.

Different plans help cover certain drugs differently. It’s your job to help them find the plan that makes their prescriptions the most affordable.

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
• Dosage
• Frequency it’s taken
• How often the client refills it
• Their preferred retail pharmacy
• If they’d like prescriptions delivered by mail
• If they would consider taking a generic equivalent of any brand name drugs, if available

Getting the specifics right is particularly essential since that’s how a formulary for Medicare Part D will be organized. If your client doesn’t know this information off the top of their head, they can generally find it by checking their prescription labels.

2. Find Out If They Qualify for Financial Assistance

There are government and state programs that can help make your clients prescriptions and prescription drug coverage more affordable for them.

Medicare Extra Help Program

The Medicare Extra Help program (also known as the Part D low-income subsidy) aims to assist eligible beneficiaries in paying the copays, premiums, and deductibles of their PDPs.

Your clients will get Extra Help automatically if they receive:

• Full Medicaid coverage
• Help from your state paying your Part B premiums (from a Medicare Savings Program)
• Supplemental Security Income (SSI) payments from Social Security

State Pharmaceutical Assistance Program

If your clients can’t get Extra Help, they may qualify for a state pharmaceutical assistance program (SPAP). SPAPs can pay for your clients’ Part D coverage entirely or at least lower the cost of their prescription drugs. Their availability and eligibility requirements can be found on Medicare.gov and vary by state.

According to CMS, three million people are eligible for Extra Help but not enrolled. Programs like Extra Help and SPAPs can save your clients thousands of dollars on their prescriptions annually, so it’s important you help spread the word about them.

Because your clients’ financial circumstances can change at any time, it’s important that they contact you if their income or resources decline. Beneficiaries who become newly eligible for Medicaid or Extra Help qualify for a Part D Special Enrollment Period to enroll in a new plan.

3. Make Sure Your Portfolio Is Ready with Contract Now

Before you get to the actual sales appointment, you need to have prescription plans for Medicare in your portfolio. It’s always nice for your client to have options, so we recommend contracting with a Part D plan in your area.

How do you know which plans to add? Start with a portfolio review with a member from Ritter’s Sales team. You can also speak with other insurance agents in your area and attend local carrier events to learn about options. Then, it’s time to contract.

Ritter’s Contract Now makes the process as easy as shopping online. You’ll add carriers’ products to your cart, review and edit as necessary, and sign to complete each contract. You can even submit contracts that require wet signatures through Contract Now.

Note: Contract Now is only available to registered Ritter agents. If you’re newly registered, you must speak with a member of Ritter’s Sales team to activate this feature.

4. Use IntegrityCONNECT to Compare Plans

Once you have your client’s updated list of medications and have determined if they qualify for additional help, you can get to the core of your work: finding the right PDP for them.

If your clients have entered in their relevant information through PlanEnroll’s Client Sync, quoting PDPs becomes extremely simple. As their agent, you can manage your client’s info and run tailored quotes from IntegrityCONNECT, a powerful client management tool.

IntegrityCONNECT draws from the information that your client entered in their PlanEnroll profile, including their preferred pharmacy, drugs, and zip code. This feature makes the quote accurate to your client, quickly giving you a good idea which PDPs will be the right fit.

Additionally, apply plan search filters for drug, pharmacy, and doctor data as well as Medicaid status to streamline the process further.

Consider these three major factors that determine the quality of a PDP — its formulary, its premium and deductible costs, and its network of pharmacies.

Medicare Formulary

Carriers define what prescription 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:

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.

Premium and Deductible

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 no-cost deductible on all tiers
• A no-cost deductible only on select plan tiers (most commonly tiers 1 and 2)
• The maximum deductible allowed by CMS on all tiers, $615 for 2026

The rest of the PDPs have deductibles that fall somewhere in the range of no deductible to the max. Just because a plan has a deductible, however, doesn’t mean it won’t be the lowest overall in cost for a client.

Fortunately, those who struggle to pay a large chunk up front for expensive medications now have the option to spread out payments into more manageable monthly amounts via the Medicare Prescription Payment Plan.

Although the program doesn’t reduce overall out-of-pocket costs, it does eliminate the need to owe a big lump sum during one pharmacy visit.

Network

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.

5. Narrow Down and Recommend a PDP

In 2026, beneficiaries in each state will have a choice of between eight and 12 Medicare Part D stand-alone PDPs, plus many MAPD plans, according to KFF.

As you’re searching, your top priority should be finding PDPs that work with your clients’ medical needs. Examine plans’ copays, premiums, deductibles, and network restrictions next.

If a client is unwilling to try less expensive drugs first, make sure you’re looking at plans that don’t require step therapy. Additionally, check if plans work with programs that can offer your clients help with paying for prescriptions.

When it’s time for you to help your clients make their final decision, provide the best recommendations you can.

Do they take several generic drugs? Suggest plans with low copayments.

Don’t have many prescription drugs? Advise they go with a low-premium plan.

You’re the experienced professional. Show your clients you know your stuff.

6. Make Sure Your Clients Understand Their New PDP

Teaching your clients what basic health insurance terms mean is a great way to set yourself apart from your competition and add value to your services.

Making certain your clients know how much they will pay for their prescriptions during the three phases of a Part D plan’s coverage is also a good move. Doing so can build your credibility and your clients’ trust in you.

Be aware that it is also mandatory for agents to discuss certain topics with their clients when presenting PDP coverage.

7. Let Them Know Other Ways They Can Save

Another way to lock in your role as an experienced professional is to inform your clients of other ways they can reduce their out-of-pocket expenses. Oftentimes, they can spend less on their prescriptions by switching to generic or brand-preferred drugs. Ask them if they’re aware of that.

Additionally, check to see if your clients can save money by utilizing their plan’s in-network, preferred pharmacies or mail-order pharmacies, and let them know if they can.

Even the pharmaceutical companies that produce your clients’ drugs may offer assistance programs to help cover the costs. See if your clients qualify for one or more of these programs at Medicare.gov/pharmaceutical-assistance-program.

Don’t forget to confirm your clients know that they have a right to ask their plan to cover a prescription drug. Their provider can ask their plan for an exemption if a drug in a lower tier doesn’t exist or won’t work for them. Providing all this information to your clients will show them you truly have their best interests in mind.

8. Encourage Your Clients to Reevaluate Their Plan Every Year

Lastly, at your final appointments with clients, stress to them the importance of reevaluating their PDPs during AEP. What was their best option one year, may not be the next. Plans can change their premiums, copays, deductibles, formularies, network, and preferred pharmacies.

Additionally, your clients could become newly eligible for additional help. Express to your clients that you’re more than happy to help them shop around and ensure they know how to get in touch with you in the future. By tackling this topic, you’re not only giving them sound advice, but you’re also securing their future business.

PDPs are a natural cross-sell with Medicare Supplements and Medicare Advantage-only plans. Those who employ these best practices when selling them will not only maximize their time, but also their production and profits.

Complete your registration with Ritter and get another step closer to finding success in the PDP market!