prescribemedicare user guide 4.3 · 2017-06-06 · prescribemedicare user guide v4.3 3 plan ratings...

PrescribeMedicare

User Guide Version 4.3 5.30.2017

PrescribeMedicare User Guide v4.3 2

Table of Contents 03 Plan Ratings 04 Identify Patients

04 Prioritize your Patient List 07 See Opportunities in PharmacyNow 10 Add New Patients

12 Educate Patients

12 Campaigns 12 Marketing Kit 13 Send an OnDemand Campaign

14 Consult with Patients

14 Open the Patient Medicare Profile 15 Plan List 18 Plan Summary 19 Plan Graph 20 Medication List 23 Email Plan Summaries 24 Print Plan Summaries 25 Compare Plans Side-by-Side

27 Enroll Patients


Plan Ratings In PrescribeMedicare, every PDP is rated for the patient and the pharmacy, where data is available. These ratings provide your patient with as much information as possible to make an educated decision. NOTE: MA-PDPs do not provide enough information to display a rating.

Patient Plan Rating The Patient Plan Rating factors in your patient’s annual out-of-pocket cost, maximum monthly cost, and the Star Rating for the plan. The Patient Plan Rating, determined by a proprietary algorithm, is a value between 1 (least favorable) and 5 (most favorable). In the Patient Medicare Profile, this rating is indicated by an arrow (▼).

Pharmacy Plan Rating The Pharmacy Plan Rating factors in reimbursement rates, DIRs, pay-for-performance, and Star Ratings. The rating may vary by patient based on factors such as whether the drugs are brand or generic and if they are 30 or 90 Days’ Supply. The Pharmacy Plan Rating, determined by a proprietary algorithm, is a value between 1 (least favorable) and 5 (most favorable). In the Patient Medicare Profile, this rating is indicated by bars.


Identify Patients Prioritize your Patient List In the average community pharmacy, 40% of patients are on Medicare. Because you cannot do this many plan reviews, we recommend you prioritize your opportunities. To prioritize, filter the list of eligible patients to where you can add value for both the patient and the pharmacy. To access the PrescribeMedicare screen, click on PrescribeMedicare in the Control Panel. The PrescribeMedicare screen lists patients that are eligible for a Medicare plan review.


FILTER To prioritize your plan reviews, use the filters on the left to identify patients with plans that meet a certain Patient Plan Rating and Pharmacy Plan Rating.For example, you can filter to see patients that have a plan option with a Patient Plan Rating of at least 4 and a Pharmacy Plan Rating of at least 4.

1. Click on Any Patient Plan Rating and select an option from the drop-down menu.

2. Click on Any Pharmacy Plan Rating and select an option from the drop-down menu.

3. If you only want to see low-income subsidy patients, click on Any Income and select Is LIS from the drop-down menu.

4. Click on Search.


ELIGIBILITY You can choose which eligibility period to view. Open Enrollment lists all Medicare patients that will be eligible to change or renew their plan for the next year. Outside Open Enrollment lists patients turning 65 (and therefore eligible for initial enrollment).

You can also filter to see Medicare-eligible patients under 65, such as those on Social Security Disability Insurance (SSDI).

1. Click on Any Age and select Under 65 (SSDI, Other) from the drop-down menu.

2. Click on Search.


SORT By default, the patient list is sorted by next visit date. You can sort the patient list by a variety of options.

1. Under SORT, click on Any and select an option.

2. The patient list will update to display in descending order. Click on the blue arrow to displaying the patient list in ascending order.

3. To remove the sort, click on Clear All.


See Opportunities in PharmacyNow PharmacyNow displays Medicare plan review opportunities for patients expected to visit the pharmacy in the upcoming week. During Open Enrollment, the patient criteria are:

• Age 65 or older • 3+ maintenance medications • Scheduled to visit pharmacy yesterday, today, or the next 7 days

Outside of Open Enrollment, the patient criteria are:

• Turning 65 within 4 months OR turned 65 in past 4 months • 3+ maintenance medications • Scheduled to visit pharmacy yesterday, today, or the next 7 days

You can schedule Medicare plan reviews with these pre-identified patients. If you speak with a patient and set an appointment, mark it in PharmacyNow.

1. Click on Now in the Control Panel to open the PharmacyNow screen.

2. Under any displayed date, click on PrescribeMedicare Opps to expand the listing.

3. To schedule an appointment, click on Schedule to the right of the patient’s information.


4. In the pop-up window, enter the appointment date and time and then click on Save.

5. The opportunity will disappear from PharmacyNow. Click on the calendar icon in the Control Panel to view the scheduled appointment on your calendar.


Add New Patients If you identify a new patient who is not currently in your pharmacy management system, you can add him or her to your Patient Engagement Center.

1. Click on the gear icon in the Control Panel and select Add Patient from the drop-down menu.

2. In the Add Patient pop-up window, enter the patient’s information and then click on Save to create a new Patient Profile.


3. In the pop-up window that appears, click on View Patient Profile.

4. You will need to add the patient’s medications before beginning the plan review. Click on the field next to Patient Reported Medications and begin typing the name of the medication. Selected the desired medication from the drop-down menu that appears.


Educate Patients Campaigns If you have PharmacyGrowth, you can record three messages to educate patients.

Visit PrescribeWellness University for instructions on recording campaign messages. Click on the graduation cap in the Control Panel to access University.

Marketing Kit Place posters around the pharmacy and use bag stuffers to educate your patients about Medicare eligibility and your Medicare plan reviews. Visit PrescribeWellness University for the PrescribeMedicare Marketing Kit. Click on the graduation cap in the Control Panel to access University.


Send an OnDemand Campaign You can send the Medicare Eligibility campaign message to identified patients from PrescribeMedicare or PharmacyNow. To send a campaign from the PrescribeMedicare screen, click on the checkmarks next to desired patients and then click on OnDemand.

To send a campaign from the PharmacyNow screen, click on the checkmarks next to desired patients and then click on OnDemand.

In the OnDemand pop-up window, schedule the call. Remember that you are limited to 100 patients per OnDemand campaign. For more information on scheduling an OnDemand call, please refer to the PharmacyGrowth User Guide.


Consult with Patients Open the Patient Medicare Profile Open the PatientMedicare profile from the PrescribeMedicare screen, the PharmacyNow screen, or the Patient Profile. To open the profile from the PrescribeMedicare screen, click on the patient’s name.

Alternatively, from the PharmacyNow screen, click on the arrow to the right of the patient’s name.

Alternatively, from the Patient Profile, click on Medicare.


Plan List Plans are always sorted by the patient’s annual cost from lowest to highest cost. You can filter the list by (A) plan type, (B) plan details, (C) drug coverage, or (D) special needs.

B

C

D

A


A PLAN TYPE You can filter the plan list to only show certain types of plans.

PDP Plans Prescription Drug Plans

MA Plans Medicare Advantage Prescription Drug plans

MA SNP Plans Medicare Advantage Special Needs Plans

B PLAN DETAILS You can filter the plan list by cost, network, and Plan Rating.

Monthly Premium monthly amount that the patient pays to the plan

Annual Deductible yearly amount that the patient pays for prescriptions before the plan begins to help pay

Monthly Avg Drug Cost average monthly amount patient pays for prescriptions

Annual Drug Cost total amount patient pays, both to the plan and for prescriptions

Star Rating CMS-provided plan rating

Patient Plan Rating proprietary algorithm from 1 (least favorable) to 5 (most favorable)

Pharmacy Plan Rating proprietary algorithm from 1 (least favorable) to 5 (most favorable)

Network plan is open network, or pharmacy is preferred for that plan


C DRUG COVERAGE You can filter the plan list to only show plans that meet specified drug coverage criteria. For example, you may wish to find plans that have all drugs on formulary but no quantity limits, prior authorization, or step therapy.

Drugs on Formulary drugs covered (on formulary) for the plan

Drug Quantity Limits drugs limited in how much patient can get at a time

Prior Authorization drugs requiring patient or prescriber to contact the plan before fill

Step Therapy drugs that patient must substitute for similar, lower-cost drugs before plan will cover the current drugs

D SPECIAL NEEDS If the patient receives help from Medicaid or Social Security, use the filter to update plan information to reflect accurate pricing.

Receives Help From Medicaid

Medicaid covers all or part of drug cost, monthly premium (up to state’s benchmark), and annual deductible

Receives Help Through Social Security

Social Security covers all or part of drug cost, monthly premium, and annual deductible


Plan Summary NOTE: For the full explanation of plan ratings, see page 3. The plan list displays a high-level summary of each plan.

If both the Patient Plan Rating and Pharmacy Plan Rating are 4 or greater, the rating bar and arrow are green.

Checkmark indicates that all

Drugs are on Formulary (DF)

Pharmacy Plan Rating is 3.32

Patient Plan Rating is 4.53

Plan ID

CMS Star Rating

Pharmacy Plan Rating is 4.81

Patient Plan Rating is 4.53

$1.9k is estimated annual patient cost;

$4,960 is estimated annual pharmacy reimbursement

Network is Open (O) or Pharmacy is Preferred (P)


Plan Graph The plan graph displays a month-by-month cost breakdown for the plan. The blue bar indicates total cost per month (deductibles, co-pays, cash amounts, premiums) and the gold bar indicates only the medication cost per month. Any coverage gap (donut hole) cost is indicated in the red tag below the month. Click on a plan name to view the plan graph.

Hover over any bar to see detailed cost information.


Medication List The medication list includes all medications from your pharmacy management system and any patient-reported medications. You can exclude any medication or add another in the Medication Playground. Click on See Medications under the plan graph.

The medication list appears.

D

C

B

A


A COLUMN HEADERS The medications list displays a high-level summary of each medication.

CO PAY / TOTAL amount patient pays / combined amount patient and plan pay

A active medication

M maintenance medication

S synced medication

O over-the-counter medication

LAST PICKUP / NEXT PICKUP

last pickup date / next expected pickup date

DS / QTY Days’ Supply / Quantity

SF Short Fill amount

RF refills remaining

B PHARMACY RECORD MEDICATIONS Pharmacy Record Medications includes active and recently inactive medications from your pharmacy management system. You can choose which medications to exclude from the plan cost calculations. Click on Included to change a medication status to Excluded.

before after

Click on Excluded to change a medication status to Included.

before after


C MEDICATION PLAYGROUND The Medication Playground gives you an opportunity to see how different medications affect the plan costs without permanently recording these medications.

1. Click on the Add New… field and begin typing the desired medication.

2. As you type, possible medications will appear in a drop-down menu. Select the desired medication based on indicated formulary tier, restrictions, and co-pay.

3. In the pop-up window, enter the desired quantity and Days’ Supply. Then click on Ok.

4. The medication will appear in the Medication Playground.

D PATIENT-REPORTED MEDICATIONS Patient-Reported Medications includes medications reported in the Patient Profile.


Email Plan Summaries You can email plan summaries directly to the patient.

1. Click on the checkbox next to each desired plan then click on Email Selected.

2. In the Compose Email pop-up window, make any needed edits and then click on Send.


Print Plan Summaries You can print out plan summaries for the patient.

1. Click on Print and select a print option from the drop-down menu. In most cases, we recommend selecting Print Selected Plans with Included Drugs Only.

2. A new tab will open and the print preview will appear. Click on Print to send the document to your printer.


Compare Plans Side-by-Side You can compare up to three plans side-by-side.

1. Click on the checkboxes next to the desired plans. Then click on Compare Selected.


2. To email the comparison, click on Email Comparison. To print the comparison, click on Print Comparison.


3. Click on a month to see a cost breakdown comparison.


Enroll Patients If the patient selects a plan during the plan review, he or she can enroll before leaving the pharmacy.

1. Click on Enroll next to the desired plan name.

2. You will be directed to medicare.gov for the patient to complete the enrollment. Enter the Plan ID in the desired format and then click on Find Plans.

medicare.gov

3. Your search will return the desired plan. Click on the plan name to enroll online, or call the customer service phone number to enroll by phone.

prescribemedicare user guide 4.3 · 2017-06-06 · prescribemedicare user guide v4.3 3 plan ratings...

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