Medicare Part D Enrollment Tools

Your 2024 Part D Toolkit
Timely Open Enrollment Resources for You & Your Patients

Open Enrollment for 2024 Medicare Part D and Advantage plans starts Oct. 15 and we have resources to help you handle the issues you will face. There are major changes in Part D benefits for 2024, and helping your patients early in the process by answering their questions and assisting them with plan comparisons will go a long way toward helping them make the best plan decisions.

American Pharmacies has prepared a customizable letter that you can send to select patients who need help with their plan choices or have questions about whether they should use a preferred or non-preferred network pharmacy. The letter is in Microsoft Word format and can be individualized with your own pharmacy logo, name and address/phone number. We also are providing a Part D bag clipper and a half-page flier that you can print to hand out to patients or use as a bag stuffer. Use the links at the top of this article to download these resources.
Your patients come to you for a reason... Identify the positives they perceive in your staff and pharmacy. Take every opportunity to reinforce those positive feelings every way you can. One of the best ways you can do that is by being a helpful and empathetic resource for their Part D decisions.

Major Part D Changes for 2024

The Inflation Reduction Act of 2022 (IRA) includes several provisions to lower prescription drug costs for Medicare enrollees while cutting drug spending by the federal government. Some changes mandated by the IRA take effect in 2024, while others don’t kick in until 2025.

  • The most important change is the new cap on out-of-pocket drug spending. After satisfying the initial $545 deductible in 2024, a Medicare enrollee will pay 25% of drug costs. They will have a cap of about $3,250 and will no longer pay 5% of drug costs in the catastrophic phase. The catastrophic threshold of $8,000 includes out-of-pocket by the consumer, the amount spent by the Part D plan, and manufacturer discounts on drugs during the coverage gap phase.

The elimination of the 5% coinsurance in 2024 will result in substantial savings over the course of the year, especially for those who typically spend large amounts monthly on medications.

Starting in 2025, a Part D enrollee will pay 25% of drug costs after satisfying the initial deductible, with a $2,000 limit on out-of-pocket costs for their prescription medications. The annual cap amount will be adjusted yearly based on inflation.

  • Expansion of Medicare Part D Extra Help benefits: In 2024, qualifications for full Low-Income Subsidy (LIS) benefits expand from 135% of the Federal Poverty Level (FPL) to 150% of FPL (financial resource limits also apply). Those who would otherwise qualify for only partial 2024 LIS status will qualify for full LIS benefits and the partial LIS benefit level will be eliminated.
  • As begun in 2023, plans still may not charge more than $35 for each one-month supply of covered insulin, and can’t charge a deductible for insulin. 

2024 Benefit & Cost Adjustments

  • Initial Deductible: Increases by $40 to $545 in 2024. After enrollees meet the deductible, they pay 25% of covered costs up to the initial coverage limit, which rises to $5,030 next year from $4,660 in 2023 . Some plans may offer a $0 deductible for lower-cost (Tier 1 and Tier 2) drugs.
  • Catastrophic Threshold: Increases from $7,400 to $8,000 (equivalent to $11,206 in total drug spending in 2024, up from $10,690 in 2023).
  • Coverage Gap (Donut Hole) begins after reaching the initial coverage limit of $5,030 and ends when OOP expenses hit $8,000. CMS estimates that enrollees will exit the Donut Hole after spending $12,447 in 2024. 
  • Donut Hole Discount: Part D enrollees receive a 75% discount on brand-name drugs purchased in the Donut Hole. Beneficiaries who reach the Donut Hole pay a maximum 25% co-pay on generic drugs while in the Coverage Gap (75% discount).
  • Minimum Cost-sharing During Catastrophic Coverage: Beneficiaries pay $4.50 for generic or preferred multisource drugs (or 5%, whichever is higher), up from $4.15. For brand drugs, beneficiaries pay $11.20 (or 5%, whichever, is higher), up from $10.35.
  • Maximum Co-payments below the Out-of-Pocket Threshold for certain Low-Income Full Subsidy (LIS) Eligible Enrollees: Increases to $4.50 for a generic or preferred drug that is a multi-source drug and $11.20 for all other drugs in 2023.

The True Impact of Preferred Networks

It makes NO economic sense to participate as a preferred provider in every Part D plan. The negative margins that you experience as a preferred provider in some Part D plans cannot be overcome through increased script volume. 

Cencora's (formerly AmerisourceBergen) Elevate Provider Network has proven that profitability is possible in Part D plans through careful plan analysis and by avoiding preferred provider status in plans if it essentially guarantees negative margins. It is important to remember:

  • LIS (low-income subsidy) patients pay the same co-pay regardless of whether or not you are a preferred provider. Full-benefit, dual-eligible LIS patients (those on Medicaid) will have a zero co-pay in any Part D plan. And remember that eligibility for full LIS benefits has expanded for 2024, adding 477,000 Americans to this category. If you have a high percentage of Medicaid patients, the impact from not being a preferred pharmacy is greatly minimized. 
  • Premiums continue to drop for many Part D plans. Also, the new cap on out-of-pocket spending for 2024 means many enrollees are no longer as pinched by costs.

Patient Loyalty Usually Overcomes Plan Cost Differences

That your pharmacy is not preferred with a given Part D plan does not mean your patients need to find another pharmacy or another plan. Patients choose their Part D plan based on many variables:

  • Monthly premium;
  • Annual deductible;
  • Drug coverage;
  • Co-pays & cost-sharing;
  • Coverage during the donut hole;
  • Formulary; and
  • The plan's pharmacy network.

Remember that patients who leave your pharmacy over a small co-pay differential are not likely to be your most profitable patients or the ones purchasing front-end merchandise or other services.

Pay Close Attention to PBM Plan Marketing 

Be on the lookout during open enrollment for communications from Part D plan sponsors and PBMs that attempt to influence enrollees' plan choices through misleading "notifications" about network pharmacies and co-payments. Be sure to alert American Pharmacies if any of your patients receives such communications.

EnlivenHealth's Medicare Match Empowers Better Part D Choices

The leading Part D plan comparison tool on the market, EnlivenHealth's Medicare Match (formerly FDS Amplicare Match) empowers pharmacies to strengthen their patient relationships while expanding revenue growth. Medicare Match helps you efficiently support patients in choosing the Medicare plan that’s the perfect match for their health and finances.

CMS-approved Plan Finder Platform – Enables pharmacies to deliver a successful plan comparison service that increases patient satisfaction and loyalty. The platform includes a convenient formulary look-up tool that suggests drug alternatives that are covered by your patient’s plan.

Win-Win Messaging – Targets patients with plan changes that take them out of network and provides them with plan options and savings opportunities via NavigateMyCare.

Medicare Messaging – Allows your pharmacy to initiate a personalized campaign via mobile app, voice, or SMS text to alert individuals to a Medicare plan opportunity.

It provides a convenient link to the Navigate My Care patient plan comparison tool.

NavigateMyCare.com – Provides trusted information and helpful comparison tools tailored to each individual patient to help them explore options and enroll in a plan that’s right for their needs – all from the convenience of your pharmacy.

► Enliven Health Medicare Match Pharmacy Resource Page

► How Medicare Match Can Help You Boost Patient Retention & Revenue
  • 10,000 Americans turn 65 each day.
  • 47% of seniors say they want help choosing a Medicare Part D Plan.
  • 80% of Beneficiaries are not on the most cost-effective Part D plan.
  • Medicare plan comparisons help pharmacies mitigate DIR risk by making sure patients are on the best plan for their needs, which can improve adherence.
  • 30% are more likely to stay with a pharmacy that performs a plan comparison for them.

To learn more about Medicare Match from EnlivenHealth® visit enlivenhealth.co or call 877-776-2832 to schedule a demo.

Other Part D Resources

Cultivating Patient Loyalty

The fact that your pharmacy is not preferred with a given Part D plan does not mean your patients need to find another pharmacy or another plan. Patients choose their Part D plan based on many variables, only one of which is cost and convenience of the plan's network pharmacies. Patients typically look closely at:

  • Monthly premium;
  • Annual deductible;
  • Co-pays;
  • Coverage during the donut hole;
  • Formulary; and
  • The plan's pharmacy network.

Uploaded via media manager.Your patients come to your pharmacy for a reason... Identify the values they perceive in you and reinforce them every way you can. One of the best ways you can do that is by being a helpful and empathetic resource for their Part D decisions.