Transcript for "Don't Wait, Migrate: Mitigating 2025 Medicare Changes During Open Enrollment": Welcome to today's agenda hosted by Enlivant Health. Our topic today is don't wait, migrate, mitigating 2025 Medicare changes during open enrollment. Thanks for joining us today. Before we get started, I'd like to highlight a few housekeeping items. Please type your questions in the q and a tab to ask questions throughout the presentation. We'll be sure to answer your questions during the dedicated q and a session towards the end of our time together. Lastly, we are recording this webinar, and we will email the recording to all attendees. And now I'm delighted to introduce our speakers. Marvin Guardado has worked with community pharmacies for 10 years. He started at Amplicare in 2015 where he held several notable positions. Marvin currently heads Enliven Health's customer enablement team for Medicare match. He ensures customers are set up for success and contributes to the product road map by aligning market expectations with product capabilities. And we're delighted to have Whit Moose with us today. Whit is a 4th generation pharmacist who graduated from the UNC School of Pharmacy. He serves on North Carolina Mutual Drug Wholesalers Board of Directors and is active in his church where he plays the drums in his church band. Witt is an avid cyclist and father of 3 boys. He lives in Mount Pleasant, North Carolina with his wife. And without further delay, I will hand it over to you, Marvin. Great. Thanks, Nikki, for the for the introduction. And today, we're gonna dive into the Medicare annual enrollment period and all the changes that, we're expecting to cause a ton of disruption this fall. So it's gonna lead seniors to review their plans, review their benefits, and shop around more so than we've seen probably at any other time, since Part d was was rolled out, over a decade ago. So as, Nikki had said, please share your questions in the chat, and we'll address them, toward towards the end. So starting with our mission and simply put, you know, we wanna empower pharmacies to optimize health, deliver quality, deliver quality, patient care, be more profitable, and and grow, and be a key key, entity in the in the community. Continue to be that. And, joining us today, as Nikki said, is someone who knows, a lot about that, right, is, Whit Moose from Moose Pharmacy in North Carolina. Whit's been a long time match customer. His pharmacy has been serving the community for a 140 years. I just was telling him before the call here that my town in Long Island was founded the same year as his pharmacy was. So a 100 and 4 years, that's that's that's incredible. And, Whit, if you could just tell us a bit about yourself and your pharmacy. Absolutely. Well, thanks, Marvin, and thanks you guys again for having me here today. It's quite an honor. Yeah. Moose Pharmacy has been around since, 18/82. So, yeah, I haven't been here that long, but I feel like it some days. My brother and I are 4th generation. We've so we've we've been doing this a while. We do have 7 locations, in North Carolina around the Charlotte area. The one on the screen there is one of our newest locations. So, yeah, we're just, you know, trying to do like every other pharmacist on the call is serve our community, serve our patients, but at the same time, you know, be a viable, a viable business so that we're able to survive and move on to that, you know, hopefully, our next generation, of pharmacists, which I do have a son that's in pharmacy school now. So, and I feel like, you know, the the topics that we're going to to go over today are vital in our survival as pharmacy because we've got to to remain profitable. So, I'm happy to be here. This is gonna be a fun fun time for all of us, and, hopefully, we can learn a lot together and and, you know, just to explore what our next year is because I think in pharmacy, we know every year is different, and and next year's gonna be another year that we're gonna figure out how to get by just like we had every other year. Yeah. Absolutely. The world, especially the pharmacy world, is dynamic and and, always always shifting. So you have a 5th generation coming up is what you're saying? That's that's the plan. So he's in school now. So, starts back again on Monday. So, yes, an exciting time for us with that too. That's awesome. And and how long have you been, offering plan comparisons for your community? Wow. So, we were actually talking about that the other day. So, we did a little bit of research, I think, and and 2007 was when the whole Medicare Part d program came about, and honestly don't remember what the 1st year that that we actually got involved. But back in the day, we knew that we were gonna have to help folks navigate this. And at first, you know, those first few years of of Medicare Part d, the plans weren't terrible. But as we know, insurance companies figure out how they're gonna make money, and it's usually off of our backs. So it got worse, each year. When we started, we were just doing a manually on Medicare's website, which is anyone's tried that. It's very cumbersome. It takes a long time. We were fortunate that the guys that developed the whole AmpliCare program, which actually back then, Marvin, you remember, was called iMedicare, were from the Charlotte area. And, we actually were honored, I guess, and and to be a part of what I would call the development of it, of the program and and I think came up with some great ideas of how the program can move forward beyond just the open enrollment time. And then as the company has grown and evolved, they haven't you guys have not, forgotten that kind of a mentality of we've gotta continue to develop and move and and see ways to make our our platform more useful. And so, I think as far as maybe 2004 was I'm sorry. 2014 was when we started actually using the AmpliCare program, to, or I met I think it was my I Medicare back then to actually start doing the, the Medicare reviews in the pharmacy, and and every year, it's just grown since then. Yeah. You you even proceed my time here by by That's right. So you're kind of like a cofounder. Oh oh. Well, I kinda feel like I am too. I'm still waiting on those checks to come in. But Well, you know, we'll talk about some of that. Right? And and how, you know, we we work Offline. To grow those those revenue stream. But yeah. No. Certainly, yeah. The the the, old team, from the Davidson community and, yeah, big big part of developing the products was to work with with you and and and your staff and and why, you know, patients needing help with this. But why why did you see this as an opportunity, to offer this and and start doing plan comparisons for patients? Well, I think at first, it started out as just how can we help the patients get the best plans for their for their drugs, and and we knew that there were differences, obviously. But then as we dived in a little bit farther, we realized too that some of these and as the plans developed, that some of these plans were horrible plans for pharmacy. And that was one of the ways that that I saw the program platform, Amplicare, migrate from a from just a a patient centered program of how can we get you the best plan to a more patient and pharmacy center program that helped us find a patient the best plan while still having a plan that pharmacy can survive profit wise. So, yeah, it really went from being more patient centered to really more, how is it centered around getting all of us a plan that we can all live with. And, of course, we're not here to serve that patient next year. That plan doesn't do the patient any good. So, and with the help of of this program, particularly, I think we're able to achieve that, to find a nice balance of pharmacy can make it, but the patient's getting an excellent plan, and they're out there. It's just a matter of figuring that out. No. Absolutely. Right. And that's what, ideally, health care is is about. Right? It's ID is is aligning incentives that that helps the provider, helps the the patient, of course. And, you know, as you said, when the program, rolled out over a decade ago, it was because it was patient service, patient satisfaction, patient retention. And and that's still a big cornerstone of it. In fact, you know, looking at last year, in terms of patients that got a comparison at our pharmacy customers, 97% of those patients that got a comparison last open enrollment continued to, fill up the pharmacy into this year compared to 76% who did not. So that 21 point difference is is huge. Right? And, and and I know it's not always about taking any revenue. Right? There's PBM revenue. There's nuance to it. Right? But, you know, what if you could talk a bit more about how you know, because you've gone into clinical service. You've been a leader in not just North Carolina, but the nation in, pushing pharmacy forward towards offering clinical services. But how do you see, Medicare patients in terms of those being foundational patients for some of these services that you offer? Well, I mean, you look at that as, Medicare patients. Number 1, I feel like they need they need us. They need their our guidance, but, really, they they are the foundation of your of your practice or at least for a lot of us. I'm sure it depends on your demographic, but but we had a marketing guy years ago, and his his approach was it's a whole lot easier to serve and to basically, I guess, sell to. That may not be a politically correct term or whatever, but that's that's what we're doing. It's face it's easier to use a patient population you already have and work with them, sell to them, if you wanna call that, than it is to attract new people, bring them in, bring them back. So that that Medicare population is basically the foundation of the clinical services. So whatever that program is, more than likely, it's going to involve someone in the Medicare program. And a lot of times, those programs are actually sponsored or provided by those Medicare programs. So all of that comes back together. It really circles back around. So let's just say if you have a plan like Humana, or let's just call them plan h, that has these clinical programs. If you have a lot of patients that are on that, there's your patient population. It might be the same with any other platform out there, so I certainly am not centering them out or saying they're better than anybody else. But it it is having a steady, stream of patients that trust you, that when you call them and offer that clinical service, they'll listen. They'll participate as opposed to you just being basically another telemarketer that that they're trying to get rid of. Right. And and, yeah, it's in in terms of looking at the patient holistically, you know, not just regarding their medications, but do they need vaccination? Do they need some point of care testing, diabetic counseling? And, you know, we've seen that if patients are open to, you know, talking about their insurance and their coverage with pharmacies, that it's an easy pivot to then talk about some of these other clinical services because you're already providing that sort of counseling, in the context of, you know, finding a viable plan, for them. And and it's not just about retention. Right? I think we'll get into it a bit here how we're, you know, providing some insight into, reimbursement and and, again, trying to align the incentives in terms of reimbursement for the pharmacy and, cost effective plans for the, for the patient. And, you know, this brings us to, the changes that we're gonna discuss here today. Right? The big changes coming to to Medicare, and we're just about 60 days away from from AAP. I feel like it it just ended, but Nikki emails me every day, every year the same time that, like, my fantasy football commissioner emails me. So I know we're we're just it's just around the around the corner, and it it feels like the ground is still shifting, beneath us. And and every year, you know, brings brings change. Right? So, what makes this year special is, there's big legislative change. Right? There was the Inflation Reduction Act that we're expecting to result in, as I said before, the most disruption since part d, was rolled out about 15 years ago. And some industry experts are expecting that there could be potentially an up to 6 70% shopper rate this fall. Now that's, like, provide some context. In normal years, according to deaf research, the shop rate is 12 to 15%. So, you know, in some indications, these are the higher estimates. Of course, there's some people saying there's 40%, 50%, but if we're looking at that 70% number, that's almost 5 times more the number of patients that regularly check out their their benefits. So pharmacies, you know, need solid information to to guide their patients and staying informed will will open opportunities for for pharmacies and, you know, certainly a peace of mind for for their patients because they're they're gonna ask, you know, they're they're they're gonna have to talk to someone about it and it could be a insurance rep at a local chain that's walking the aisles. It could be a broker that, you know, may not be aligned with the goals of the pharmacy. So so it certainly behooves the pharmacy to to insert themselves, in in that conversation. And gonna just go over a high level recap of some of these major changes. And and first up, you know, we have the the again, I said before, the inflation reduction act and its significant implications. And it's being it's been rolled out over the last couple of years. Phase in over the last couple of years with the $35 insulin caps, $0 cost sharing on on vaccines. But, 2025 is the year that that big ticket item, the $2,000 cap goes into effect. And and we'll dig deeper into that on on the next slide and throughout the presentation, but that is gonna have huge implications for the for the program. And, you know, another aspect of the r IRA that wasn't being talked about nearly enough until recently, until the last week or 2, is the prescription payment plan, also known as the smoothing provision. And and this allows patients so so so that means, you know, patients won't pay for medications at the counter. Instead, they'll finance it through their carrier. And, it's an opt in program. Right? So patients may hear about this and may think they're automatically don't have to pay at the pharmacy. They do have to opt in, in order to take advantage of that program. And we've heard customers, recently on both ends of the spectrum. Right? Some are concerned about potential confusion, you know, the administrative burden at the pharmacy, again, because of patients not understanding the program or what the enrollment process looks like, which which is still being communicated or hasn't yet been communicated fully. It could be something that that differs from carrier to carrier. We we haven't seen something standard, from CMS in terms of how how they they would, how that would work. So, again, it's not not automatic, and and that's certainly something could change in the coming years where if patients have a x amount beyond an x amount, of calls per year that they're automatically, enrolled. But then there's others. Right? Other pharmacies we talked to see this as an as an opportunity, where they'll look to actively enroll patients, you know, once we kinda learn what that what that looks like. Because they won't have to worry about charge accounts or credit card fees or, you know, any of those other fees that that add up over the course of the the year. Because the way it's it works, it looks like, is that pharmacy will be paid the full amount, including the co pay, by the plan with standard payment terms of 14 days, and it'll be consistent with the contract reimbursement rate. So curious with, you know, if if you had heard anything about the program and and and how do you see it? Do you see that it could be, you know, confusing, burden for the pharmacy, or do you see that as an opportunity? Well, I honestly have learned more about that from you, Marvin, in the last week than I knew anything about it previously, and I feel like probably a lot of my colleagues feel the same way. This might be the first time they're hearing of it. So to me, it obviously sounds like it could be a huge headache for the pharmacy because it could be very unclear about how things happen, and I think there could be, tons of confusion on the patient's part that they don't know what's going on and and the time things that we may end up trying to have to figure out for them, explain to them. So, it may work out great, and it may be a great thing, obviously, if if someone needs that that option of of perhaps postponing the payments or whatnot. To me, it seems like it could be something that gets really confusing and and and is a real headache. But but, honestly, I don't know a lot about it yet just like all of the change, really, that are gonna go into effect next year. So that's why I think it's, yeah, as I say, I've learned most of this from you and and you guys, because you are looking at all this, and I think it's great that we're we're becoming aware, and we can start to make a plan of what we're gonna do and and how as this develops and as we learn more about it. Obviously, you know, we can you guys will keep us in the loop on, and I feel like whenever possible, there'll be ways that we can can work around that work through that using the platform. Because, really, in Medicare time, this platform is the go to. You gotta have it. You gotta have it open on your computer the whole time because it's, just something you're gonna refer to constantly. Yeah. No. Absolutely. And the thing with this year, because of all these changes, there's usually, carriers start to release some of their first looks, around this time of year or even earlier in late July. But we've seen that has been delayed a bit by most carriers. And even this program, right, it's unclear exactly like I was saying before. Like, is there is not gonna be, at least this 1st year, a standard approach that's provided by the government could be where carriers are treating it differently from one to to another. So, you know, we're certainly, keeping our our eye on that and see how if it is something pharmacies want to encourage patients to do, they see as a benefit, that we can facilitate enrollment possibly, right, with some messaging campaigns, some handouts to, initiate enrollment. But it still yeah, certainly remains to be seen on exactly how that will roll out and if in turn it's a and it's truly a benefit, for the for the pharmacy. And, you know, again, going back to the, you know, to the inflation reduction act that's been phasing in over the last couple of years. And and and, again, you know, 2025, that $2,000 cap goes into effect. And here's a look at the, coverage phase, the stages of coverage, starting next year. So you'll notice the doughnut hole is is is gone. Right? So patients will, with drug cost over $2,000, again, will not pay anything. And there was a a cap issue of $8,000. There was $0 cost here in the catastrophic period, but but again, that goes down significantly to to $2,000, next year. And, you know, that's a big win for patients that are on specialty meds and high press high price medications. But but what happens, you know, the cascade of what that causes, because the carriers are not, you know, they're not they're very much for profit companies, and they're not gonna just eat these costs. So that has to be made up somewhere. And in terms of prescription drug plans, those standalone PDPs, they really only have 2 areas to to maneuver around. And that's gonna be premiums and formularies. And, you know, if you're a customer, you can log in to the application now and download this infographic from the, resource section. And, we have a poster version of it too if you wanna just paste it up somewhere in your pharmacy. But certainly it's gonna cause a a lot of disruption and, turning it to to to you, to you, Whit, is, you know, have your patients, I know it's early, but, you know, have you heard have you discussed any of these have they discussed any of these concerns with you? Like, when do they typically start talking to you about, what their plan options are for next year? Well, I think ours are trained to know when October rolls around. I gotta get my I gotta get my appointment. I gotta get and it amazes me how many of them want it that first day, which, we tell them no. Don't do it then. There's just there's too many variables at that point with too many things we don't know, but, it'll be interest I haven't heard anybody specifically mentioning any of the changes yet, Marvin. It but it will be interesting to see how much education they get. And as we know from the TV ads will start very soon, I'm sure. They're gonna make it sound like it's the greatest thing. So it will definitely be up to us to learn what these changes are going to mean, be able to explain them, because I know that we're gonna hear way more, and we're gonna have to see through the smoke and mirrors that that this this is probably going to be because as you say, the the carriers are not gonna subsidize this. They're gonna get their money out of it somehow. And so we need to be aware of those those schemes and be aware of that because there are gonna be those that don't know and who are just gonna blindly go in to their same plan they've always been on because they like it. And those folks are liable to get, a big wake up call when they see that first statement come through in January. Like, well, wait a what happened to my premium? So, it's gonna definitely be up for us up to us, I think. We're going to be diligent about this to number 1, you know, be aware, stay aware, figure out what is going on, and then make our patients aware of that through whatever means. And I think we'll talk later about ways to communicate with our with our folks. But, there are several options, and I think we need to be ready to pull the trigger on that as soon as we know something. Because the earlier we can get this into their hands, the more they're gonna come to us for that as opposed to going to an agent, or someone like you had mentioned earlier that really doesn't have their best interest in in mind, but but they their own best interest. So, it'll be interesting for sure. But as of now, I've not really heard anybody, you know, any chatter on it as far as patient wise of what's gonna happen next year. Yeah. And that that makes sense. Right? The, patients typically start receiving these these, they're called, which stands for annual notice of change towards the end of of September. So we anticipate around that time, are they gonna see, like, hey, my premium's going up x amount or this medication has now dropped. And and that's when a lot of questions are gonna come in. And it's an election year, and there's gonna be mixed messaging everywhere. Right? So, the way this is gonna be positioned is gonna change from one day to to to another. But certainly, you, you know, having that information, knowing their coverage, knowing them. Right? What's better for them? What's, providing them with that service? And seeing them multiple times a year, you're gonna have their best interest certainly in mind more so than than, anyone else. And you bring up a good point is that a lot of you know, just like you, a lot of our customers have been doing this for years. They know, you know, let's start booking appointments really in November. Right? The beginning of November. Because that first two weeks of of of AEP, the annual enrollment period is, the drug prices are kinda volatile. Right? They they they kinda, are all over the place, so they tend to stabilize around the 3rd week of of AEP. And, unfortunately, that just really leaves us with with a month, but a very busy and, you know, certainly, potentially productive month. Right? Because what whatever pharmacies are talking to patients about during that period of time and they collectively come up to an agreement on which plan is best for the patient is, in the pharmacy terms, they're locked into that for the year. Right? So if there's any inaction from the pharmacy, there's some exceptions, but for the most part, these patients are locked in for the for the for the coming years. So so certainly November, is, is is gonna be a huge month, as these things stabilize. And I said, some customers are saying, like, I'm gonna wait till the election's over to start booking, so so that, you know, very well could be, what we see across the board. Well, and I think you bring up another good point there too, Marvin, because when they do get these letters, I would guarantee you that every one of every pharmacist on this this webinar today has had a patient bring them a letter. What does this mean? And and that's gonna happen this year for sure. This is what I got. And and, and, also, there's probably a lot of them that don't even open those letters. So, unfortunately, there's still that part of it, but but I know we're going to get a lot of people bringing these letters in. Well, what does this mean? Does this really mean my premium's gone up by this much? So, there's more to open enrollment period than just saying, okay. We're gonna do we're gonna do the consults this year because you've gotta allow for all of that. You gotta allow for that time for that person who's just gonna walk in and say, what does this mean? You gotta, of course, allow for the actual consult, but there's so much more that that goes into open enrollment time than just saying, you know what? We're gonna do consults this year. So, yeah, that's that's a good point that that's gonna be another thing. There's gonna get letters that they don't know what that means, and it's up to us to help them decipher that, which is good. They need us to do that and not some some third party that doesn't have any of interest, of except for their their own personal, how can I sell this person a plan that makes me a commission? Right. No. Absolutely. Inserting yourself in the conversation is key and, you know, that's something you've done since the onset, as you said, of of this, this program. And, you know, again, same before, you know, some some folks predicting potentially 70% SHOP rate, and, you know, on on paper, that is good, as we said, for for those patients who are on those higher medications. But, those two places where carriers will compensate, on the PDP sides are gonna be, as I said before, premiums and formularies. So we're likely to see more cost sharing across those formularies, right, with higher cost in in probably each of those tiers. Right? And removal of some drugs altogether. And we started to see some of that last year. I know some some some insulins were removed from formulary on some PDPs. And the expectation that's gonna be, more, it's gonna be a broader situation in terms of removing drugs off formulary this year. You know, if you look at some medications that might have had 5 or different brands for a particular diabetic or cholesterol drug, right, that should be significantly reduced, especially on those low premium plans. You know, last year, there was a PDP prescription drug plan that had an average 50¢ premium, across the across the country. And, that plan was very poor in terms of reimbursement for the pharmacy. Right? So so that plan, we could see all of a sudden not being 50¢. Right? Being a lot more, not being as attractive to to patients, heading into to next year. So there's, again, there's gonna be some give and take, and formularies is especially an area where we we expect to see that. And regarding premiums, you know, we got some information earlier this summer that the, and to give some context, you know, the average national premium, has typically been around 33 to $35 a month on EDPs over the past few years. But just a few weeks ago, we were hearing that, the expectation is that those premiums could jump to 65, $75 on the the higher end. And then just a couple of weeks ago on July 29th, CMS took a closer look at these plan bids and realized, like, this is heading in the wrong direction. And, you know, we've been saying this for months in our training webinars is that premiums are set to double, triple, quadruple. They're set to skyrocket. And, you know, finally, when the plan bids came in, the government stepped in with the, it's called a premium stabilization plan offering subsidies of $15 per month per member to these insurance companies if they keep premium increases under $35. And, you know, carriers just found out about this a couple weeks ago, so we're still waiting to see if if they'll take the deal. And if they don't, or some do and some don't, you know, we could be looking at those $70 premiums going into, for PDPs going into to next year. And, you know, on the Medicare Advantage side, carriers have a bit more flexibility. Right? They have more levers to pull because the last thing they wanna do is touch premiums on Medicare Advantage Plan. It's been such a gravy train, in the last few years for for carriers that that's the reason that they've attracted. One of the main reasons they've attracted so many members the last few years is those $0 premiums, especially if you compare it to, you know, this potential, increase. But but, again, they can adjust the health maximum out of pocket. They can change doctor networks. They can cut back on Uber rides, to the doctor, on gym memberships. You know, those ancillary benefits are likely to be, watered down and, you know, curious to for for you and and your pharmacies. Have you seen that over the last few years that there's been more interest in advantage plans? How has that looked in your market? I think there definitely has been more interest. I think there's still a subgroup of folks out there that still have a negative, a negative view of Advantage Plans, and I think a lot of pharmacies still have a negative view of Advantage Plans. But my take on those is a lot different. I think they're they're a really good option for most folks, and I think they're a good option for for pharmacies if you've got, you know, a good a good group of plans in your area, and that I have seen that obviously too. I know you have too, Mark, where some some areas just have don't have a good advantage plan to offer. So, it's certainly, by region as to how that works. But, yeah, there's definitely been a shift, I think, and more interest in those. And I believe that this year, we'll see that that even more. And I think those folks that have been so hesitant to go that route historically are gonna have to look at at that as as an option, because they I think, you know, made another good point that they're gonna have to figure out ways to cut costs too. So, historically, I think they've actually tried to add add perks to their plan, like the gym membership, like the Uber rides, like meals, and things like that that that they've put on to their plans to make to entice people to get them there. And we may see that some of those perks go away, so that'll be interesting to see too. Yeah. Certainly, some of those things that attracted folks that maybe weren't so relevant to insurance, bought a lot of business, for some of these carriers, and now they're analyzing that and realigning their their offerings. And one thing that we've we've seen, we've heard is that, you know, one benefit that's probably not likely to get, watered down or at least, pulled back is the, you know, OTC benefits that somebody's advantage, carriers offer for their for their, patients and their members. Right? That that's gonna continue to be, a benefit going into 2025. And and plans offer a monthly stipend of, say, you know, $100, that patients can use at at the pharmacy for vitamins, supplements, other OTC items. You know, for those low income folks that maybe are nutrient deficient on, a statin, they're taking a statin and, you know, you killed q 10, but they haven't wanted to pay that out of pocket. Right? This is basically free cash for for them and certainly, you know, if if pharmacies are able to leverage that, more revenue for for the pharmacy as well. Have you, seen patients with more of these LTC cards recently? Well, obviously, that was a big push for us too was to try to find plans for our folks that that offered that, and and we've pushed it on our folks. I don't I won't say that it's been a huge revenue maker for us, but it certainly has been, and it does if we can get that train that patient trained to know, okay, it's time for me to refill my vitamin scan or it's time for me to get some whatever. Let's get that from the pharmacy and build that into our service to them. Hey. You need this. So, another little tidbit I'll just throw in there that we have patients that that are in some of our zinc or adherence programs that might be getting vitamins every month. They might be getting aspirin every month. They might be getting whatever in their zinc packs, and it's an opportunity for them to use that card to buy it from you as an over the counter item instead of having to pay you, for through the pharmacy, and you still get you you still get paid for what you're doing, but the patient actually is able to use that benefit. So there are ways to to leverage these things, that benefit the patient and the pharmacy. Yeah. Certainly could be a new revenue stream to to activate, and and it seems like you know, certainly, my area, there's so many, like, OT every pharmacy I see says we accept OTC network and Mhmm. And that's becoming a lot, you know, more and more prevalent. And, so so with, you know, in a normal year, if you know, if there ever is 1, how many of your patients typically receive a plan comparison, during AAP, and and are you expecting that number to grow this year? So, yeah, we're definitely expecting the number to grow this year. I did some some research on that and it looks like right so, just to to clarify, we do have a person who actually does those for us. So while while the individual pharmacies will do a review occasionally, we do have an individual that will actually go through our 7 locations every day at one site, and we'll do them. So we did actually over 500 reviews last year. A lot of those were people who didn't make any changes. They just said, okay. I'm I'm on it, and I'm gonna stay there. If we looked at it, we probably had about 25% that actually did either sign up for something through us or made a change or whatever. So, I mean, that's still a pretty significant number of folks, but just that we touched 500 plus that came through, if nothing else, we hopefully confirm that, yes, the plan you're on is still the one, but there again, I feel like they're gonna come back to us. They're gonna ask us, what do I need to do? And and there's there is a certain bit of word-of-mouth on that too. So, you know, miss Smith has had great success the last 3 years with our service. She tells her friends about it. They're coming this year, so a lot of word-of-mouth comes, So, yeah, it's it's a great opportunity, and I definitely think that we're gonna see that grow this year as people who have been comfortable before. I'm not gonna do anything this year are gonna have to look at that as these changes become effective next year. Yeah. Absolutely. And those yeah. Well, those 500, right, those those 75% who who didn't switch, they could have otherwise someone could have got in touch with them and they could have ended up switching pharmacies or on a plan that's out of network. And we've seen more pharmacies in the past few years declining networks. Right? So especially those pharmacy do that, they need to insert themselves in this conversation because if they let us out the chance, then they're signing up for something else that they can't come and fill going into next year. That is a great point. I mean, that if I would say if there's no takeaway from today, from my pin in my opinion, what you just said is probably the when it comes to a bottom line dollars and cents, if you let them go somewhere else and they sign up for a plan that's out of your network or a plan that you just can't survive on, you know, that's a race to the bottom. So you gotta insert yourself into that. Absolutely. And, you know, in terms of inserting yourselves, right, is how do you prioritize? Do it smart, be efficient about it, and, you know, the way we we wanna help pharmacies do that is deciding, identifying, you know, who go with the flow of the market. Right? Focus on those patients who are gonna lose coverage on at least one of their medications or ones that are gonna see an significant increase in in premiums. Right? These are the patients that should be, hearing from you because they're if they do nothing, they're gonna see a negative impact going into next year, reduction in benefits or an increase in cost or or or both. And, you know, once we have that information start, reaching out to to to them and kinda brings us to our next question is is how do you go about that that outreach, with with your customers? You know, how do you go about letting them know, about comparing plans? I mean, some of the a lot of them already know. Right? But just expanding that word-of-mouth, how do you go about doing that? I think that's a great question too. So, well, there there's obviously you know, there are several ways of reaching out. So I think the first question goes back to what where you started with this line of thought was, how do you choose who you're even gonna pick? So you can go generic and just say anybody who's over 60 5, I'm gonna send them a letter. I'm gonna send them a fax. I mean, I'm gonna send a text or whatever. But for us, we felt like, if we had a bad plan in our area, that was, you know, we were losing money on or that that was just was a bad plan all around. That was an easy target. Obviously, I think if you can cover everybody and there's ways of doing that with using the platform, but, basically, how how do we reach out? We have some stores that still wanna do mail, just old fashioned letters because their patient population still responds to that. They still like to get that paper letter in the mail that's in a seeing that it comes from your pharmacy, and it's directed to them. Hey. Now is the time. And it can be plan specific. You know? But there's there's all kinds of things we can do now. We can send different mailers out to people that have good plan versus bad plan, to people we don't even know. And all this, we we actually use the Enliven Health AmpliCare platform to do, text messaging. Campaign is an easy one to do, and and, basically, it starts and just does its own thing. I'm not sure the stats, but we're talking about yesterday. It's like most people will look at a text message just in, like, 3 seconds of getting it. So you're going to reach patient with a text message, even the older population now. Emails, if you've got that available. So, all of these things are are valuable ways to reach out to your folks, and most of them with just a minimum amount of preparation, you can get those out. A call out is also with your recorded voice, works really well too. And you certainly can do any number of those things, And we've tried all of them. We've had some of them that were disastrous because our planning was very poor. But, the key to it is to plan, pick out what you're gonna do, figure out who you're gonna send it to, and, really, anything that you do is not wrong. So just get get your name out there to as many people as you can and be prepared. Yeah. No. Absolutely. And, you know, in terms of spreading the word, right, what works for you, you know, could could not work for maybe doesn't work for for for, you know, another community. So spreading the word, you know, letting patients know, letting the broader community, local partners know that you're offering this service and think about what resonates most with your demographic, whether it's personalized calls, text messages, as Whit said, mobile app, if that's something your your patients have downloaded on their phone, email, or even, you know, snail mail. Also, you know, whatever works best for your customers, that's the channel that you should use to to communicate, about this service and then specifically about these changes and how they'll impact, that particular patient and their drug But the key to that too, I think, Marvin, is you gotta have a database to get that prompt. So whether it's your pharmacy software, whether it's from from, you know, the health platform, whatever that platform is, you gotta have a base to get who get them and figure out who you're gonna send those to. Filter them out and get them out. Absolutely. And, did I skip up? Yeah. Yes. So, no. So that's a a a great point. And there's, you know, pharmacies like like like you, right, that prefer a hands on approach, you know, doing those face to face comparisons with patients right at the pharmacy. And, you know, best practice we've heard from, some veterans is a is a scheduling tool. Right? So if a lot of pharmacies started using schedules, appointment schedulers for clinical services, to set up some slots for for Medicare, plan reviews and, with how how do you go about it? Do you offer a scheduling, option for patients? And if so, yeah, how many slots do they have, during during AEP and and also outside of AEP? Yeah. So we do have it's it's, it's a scheduling app that's embedded within our website. So it's easy for us to just tell a patient, you need to go to moosepharmacy.com and and sign up. There are slots every day. They're 30 minute, 45 minute slots, I believe. I don't even know. I mean, we trip you you we wanna try to get as many in as a day we can, but really that does itself, and that's definitely worth the investment in that tool, because, whether you do it yourself or the patient calls in and you you schedule them or actually give them access to the scheduler that so they can do it themselves. Scheduling is is key to making it work. Yep. Absolutely. And that keeps you've been organized and, it it we, you know, we recommend, you know, offering, like, 2 hours per week outside of open enrollment in at least in at least 2 hours during, AAP. And and some pharmacists like you would, you kinda have a dedicated person. So if you have a mission or someone who really wants to take on more responsibility or this could be a project that they own and that they develop, that program further. So I'm gonna speed it up a bit because I wanna get to a lot of questions that we have here. So kinda throwing it out to you. Just generally speaking, like, how has utilizing software, right, whether it's ours or just generally, streamline your comparison operations compared to how you were doing it before, right, when, you you were going on the government website. Yep. You absolutely cannot get by using the government website. You gotta have a platform. So just no further discussion on that. You you just can't do it. You can't do it efficiently. Your time is way more valuable. I I don't know of a better platform than, and we've never used another platform, but I have seen where people have tried and they've offered, but yeah, you got to use a platform to streamline that process or or you'll never get enough comparisons done. Yeah. Absolutely. Having to manually add drugs, you know, some of these patients are on 8 plus medications and then creating a profile for them and that, as you said, like, during the fall, there's vaccines, there's there's flu season, a lot of people catching up on NTN. So there's a lot going on. Last thing you wanna do is manual work. Absolutely. That's the worst time of the year for open enrollment, but it is what it is. So you just gotta do it. Right. And and what would you recommend as the the first step to to getting started with setting up a program, right, and offering this type of service? Well, of course, you gotta decide you're gonna do it, and you got to devote some staff to it. You gotta have a platform to do it on. We you know which one Marvin and I think are the best is the best one. And you gotta schedule your folks, whether it's a day a week or a few hours a day, however it works best, you know, for the situation, but but those are the keys. And then in the meantime, you gotta you do your your prepay your preparation to be ready. You gotta understand what's happening with the with the landscape, for this upcoming year. But your preparation and and just, knowing what you're doing, get that person in there, keep them on task so they're not telling you of every pill they take and why they take it. You know all that already. Just try to be as efficient as possible because you're gonna have a ton of patients to see this year, and we gotta get as many of them taken care of as we can. Absolutely. And, gonna go ahead and and just move up a couple of slides. And, you know, we got we got a lot we've got a lot of resources. You know, we have a series of webinars this going into this fall starting with this one. We have an ebook that you can download with this, QR code here that dives into this topic, bit more. And, you know, our goal is to to help pharmacies, and we've said before with with our mission to offer that patient care optimized health, and, just help pharmacies navigate through this great Medicare migration whether you're working with us or not. Right? So we a lot of us that work here, we used to work at pharmacies. We have some that we're pharmacy owners, our pharmacists. Right? So we care much very much about this profession. So whether you're working with us or not, please, you know, download these resources, rewatch this video if you find found found it helpful. And, you know, hopefully, that's something that allows you to get a head start on all these changes that are happening, this this fall. So I'll leave the QR code there for another few seconds. And, we have quite you may not be able to get through all these questions. There is a ton. Wow. The chat is going off. So any idea when the, Cynthia says, any idea when the 2025 plan info will be available? So typically, the editor lease by CMS in, October. You know, a lot of the things that we've been hearing are just what looks like the direction that a lot of carriers are gonna go, but formularies, premiums, all those things, are, provided to the public, come October. So we have, Julia saying, as a multi store owner, can I view all my patients across locations? So so so yes. So, you know, if you have, like like, with you have 7 locations. Right? Yeah. You sign up your multiple locations, and then there's an admin view. So you're able to log in, and then from there, access all your pharmacies from that that login. So we we do actually have, some folks that that do that. How how do you go about, managing all your locations with this program? Exactly what you just said. I used it yesterday. It's site specific. So if I've got a patient, and I use it multiple ways, but, yeah, I won't elaborate too far. You answered the question, and, yes, it works. I use it all the time. Awesome. So we Charlie says, do you work with LTC pharmacies? So, great great question. Because actually, if you look at medicare.gov to today, like, just go on log in right now. Oh, not log in. Just go ahead and access that sizing. You'll see that cost estimates are very inaccurate for patients filling prescriptions at long term care pharmacies, and this is because CMS the CMS data for the Medicare plan finder, doesn't include LTC contracting data for network status or drug pricing. So as a result, around 40% of plans, Medicare plans show up as out of network for LTCs on the government website. And, you know, additionally, for stores that do show up in network, those patient cost estimates, they're based on retail contracted rates and dispensing fees. So this often leads to, co pays and coinsurances being quoted on the government site that are much lower than what the patient actually has to to pay. So we worked with, LTC customers and, you know, knowing this, kind of developed the proprietary algorithm that analyzes LTC claims data. And, you know, as a result, you use Medicare match with LTCs. It's gonna be the most accurate plan finder on the market, even including the the government site that that again is really just set up for retail and, hasn't adjusted to, providing any inaccuracy for, for LTCs. Let me see what else we got here. What Keith is, what happens if they go multiple pharmacies? So, what happens if they go to multiple pharmacies? So I think Keith question is more about, you know, pharmacy. If a patient is filling at at at at his pharmacy and maybe, you know, a competitor down the street. So we integrate with your PMS, with your pharmacy software. So we're just bringing in the prescriptions that are being filled at your pharmacy, but you can manually add medications. Right? So if they're filling 4 medications with you, 3 somewhere else, we're gonna pull in the 4 from the integration, then you could manually add the other 2 or 3, and it's gonna adjust all the plan prices, to that new list that you've, you've updated. Have you come across that, Whit? I'm sure where there's some people that are filling 1 or 2 meds somewhere else. We have, but, honestly, not so much anymore because we've told them, you gotta get all your stuff here, and we can and then we tell them why in the plan comparison. We'll do that. I will just mention too, you can choose CVS as part of the plan comparison, Marvin, I believe, or or Walgreens, wherever. So if they're getting something at CVS, it takes a lot of extra work to do or time, I guess, to say, okay. Well, if you got it there, this is how much it would be. And if you get it here, this is how much it would be. And do you really wanna pay even if it it's usually not gonna be less, but it could be since we know there is a chain or 2 that owns an a PBM. But but let's just say it's $10 less at CVS or $3 less at CVS. Do you really wanna pay or do you is that worth it for you to put up with that service and that weight? So it it there's a ton of information in available in the platform that you could do such as that if you really wanted to to do it. But, yeah, you can just manually enter and say, this is how much it'll be here. Yeah. No. Absolutely. It's a good point about the, nearby pharmacy tool where you can basically mimic what those plans will cost the patient according to their drug profile at nearby, you know, big box changes as as with so certainly allows you to fully compare what the patients, gonna gonna pay at at your location and a competitor. Let me see. So Clinton says, if it takes 6 months to shoot. Where'd it go? If it takes 6 months to pay the bill with the payment plan, how long does the pharmacy have to wait to get payment for the co pay? So this is in regards to the smoothing provision, the Medicare payment plan. So, so the way the language is written, the pharmacy is gonna receive payment within 14 days on standard terms from the PBM. So I wouldn't, the 6 months to pay the bill with the payment plan, I'm not sure what that's referring to. I know the the patients, if they go, I believe, about 2 months without paying, then they're 2 or 3 months, they're disenrolled from the program, and, and they're not able to sign up for the program for for at least another year. But it they they're not kicked off the plan. So so that's, again, something the carriers kinda have to figure out. They're they're becoming lenders in a way, when they're bringing on taking on these these premiums, but they are the way it is written, having to pay the pharmacy within, 14 days. See what else we have. Marvin, I I saw several questions that look like that ask if we charge for the service, and we do not charge for the service. We just felt like, that's not what we do. Right. This is a pay you know, this is in order to help your patients navigate through a really difficult, system, and there's things in place, right, within the program where pharmacies there's financial benefits to pharmacies. Again, if you are on a plan or patients on a plan that is reimbursing you very poorly, but there's a better option for the patient to save money that also benefits the pharmacy, right, that's additional, reimbursement revenue that you, locked into the coming year. And, you know, a new feature we have now, if you customer, right, you can log in and, you can go in. We've talked to our customers and we found they told us that, you know, what's the line in the sand where they say that reimbursement on brands is is I can I I just can't get it for that for that amount, and that was AWP minus 22%? So we added in app is that if you're comparing plans for a patient with at least one medication, plans that are reimbursing below that threshold will have a profit loss tag on there. So you can quickly identify, okay, this is not gonna be good for me. And what we're gonna be adding ahead of AEP is, a filter where if you wanna just view plans that are above that threshold, that filter view will provide you with, that that shorter list of of plans. Because because, again, what we wanna do is patient first, but you also wanna know, as you said before, right, if you're not around because you had to close your doors, then that patient, what are they gonna do? That's a big issue with pharmacy deserts and and and adherence and and, ultimately, you know, leading to poor health. So this is certainly another way in which you can drive reimbursements without collecting a payment directly from the patient from us. So Deborah said also, was that a yeah. Sorry. I guess it was too long of a answer. Was that a yes or no that you work with LTCs? That that is a yes. That that's a yes. Sorry. It was, I guess, too long winded, but it was, it was a yes. And what I was saying is that if you go on the government website to offer comparisons for, at an LTC pharmacy, you just you will be giving the patient incorrect quotes that are lower than what they actually have to have to pay. So Tessa said, can you repeat the AWP part? Yes. So we added a tag within the plans list. So if you're comparing a patient, plans for a patient on at least one brand medication, anything that's reimbursing below worse than AWP minus 22% will have a profit loss tag. So you can quickly identify, like, that is a potential big loser for me and, you know, at least put on the caution lights for you, and and give you an idea on how to, how to proceed. So Deandra said, how does, Medicare match compare to Amplicare? So this is our opportunity to let you know that Medicare match is Amplicare. So we we used to be iMedicare. We rebranded to Amplicare, and now Medicare match is is Amplicare, is what that that program, that you're more familiar with. So Nikki and Ryan, we we have to get the word out. Looks like, Amplicare is Medicare match. Let me see. So, Gus, can you use the software between now and early November for guidance? So in terms of like, our customers had access to the software throughout the year. So, what you can do is help your dual eligible patients outside of open enrollment, help your newly eligible patients as they're turning 65. And then the Q1 of the year, you know, we said how Medicare Advantage is becoming a lot more prevalent. That Q1 of the year is open enrollment for Medicare Advantage plans. So that means that anyone on a Medicare Advantage Plan during January, February, and March can switch to another Medicare Advantage Plan. And, you know, that split is 5050 right now across the country between original Medicare and Advantage. So if we extrapolate that to your democ to your community, then half of your patients are able to switch plans really for 6 months of the year. And if you're asking, like, if we can go into the software now, we do have an info session next week where we do dig into the actual, software. Yeah. I think too, his maybe his point too, Marvin, is can can we use it to practice? And would be a great get your people loaded. The other thing, Marvin, we really touched on, which we should, is, in your pharmacy software systems, you need to get these patients loaded correctly. We still have issue with that at our stores that there's so many plans under each carrier that are different. And you need to especially know, is that a PDP plan or or is it an an advantage plan that this patient's got? And you can do that using your eligibility tool within your software. Get that stuff loaded into to, Medicare match. Thank you for clearing that up for me too, by the way. So that when the time comes that that you're working with the people, you've got that information loaded. You get you're using accurate information to compare. If they're on your scheduler, get them loaded into Medicare match. Get the plan loaded into Medicare match that they currently have so that the data that you're sharing with them is accurate. You need to know this, and if you don't, like I said, I've got well, some of our pharmacies that are still not getting those plan those plan, loaded correctly in the pharmacy software, and that drives me nuts because we can't give them accurate information unless we got that. No. Absolutely. Running an eligibility check is is is key and and and, Gus, you know, reach out to us, email us. If you're a customer, we hold webinars, training webinars every other Wednesday. We're gonna move them to weekly here in the coming month as we get ready for for AEP. But certainly, yes, start practicing, having those conversations with your dual eligible patients, and, and then we'll, you know, you'll you'll be able to to be prepared for for this fall. And I know we're over time. One last comment really from Tyler is that we started accepting OTC cards this year. There's been a big value add for our customers plus a big revenue bump for us. Most of our stores are rural, so they would have to drive a long distance. So absolutely. Right? This is money that otherwise these folks would not have, and, what better place to to spend that than than your pharmacy. Yep. And I'll just tag if I just 30 seconds to tag on to that. Sometimes, I will just say we have plans in our area that are better than others, and some offer these co pay these OTC cards. So even if they're not using that cut that OTC card at our location, but it's an advantage to that person, and they can use them at grocery stores. They can even use them for power bills and things like that unless that's gonna change for next year. So I use that as a tool to get them to see that plan a is better than plan b, and that's a reason they so, yeah, it's great that the that your pharmacy's getting it and you're using it. But even if you're not, if that gets that patient to take that plan and you're getting better reimbursements because of it, use it to that advantage also. Absolutely. It's a great point. Again, patient first. So that's something that that is helpful to the patient no matter where they're they're using those those benefits. And, so I know we went over. There's a ton of questions. So we're gonna review them all and try to address them all via via email. So thank you all. The chat was popping off today, so thank you everyone. And, you know, I'll just close by saying that, you know, we've been a leader in this space, and and this year is, as we have noted, you know, been it's gonna be the most disruptive ever. So, you know, we'd love to consider, you know, have you consider partnering with with us. And if you're already working with us, we sincerely appreciate it. But if there ever was a time to to reassess, to find the right tools to navigate this year's, disruption, then, you know, Medicare match is is is what you need. So we certainly hope you found this helpful. Thank you for your time. Whit, thank you so much for for your time, your guidance again, and really taking this product to where we have with, individuals like yourself, which are really pushing the the profession forward. So I very much thank you for for your time and and your words of wisdom here. That's great, Marvin. I kinda feel like we're the Batman and Robin of Medicare. That's right. Well, I'm definitely, not the Batman. I'll I'll take the Robin on that one. Thank you everyone again. You know, we'll look to, we'll look over all your questions and, you know, hopefully, we'll be in discussions with most of you here, throughout the rest of the year. Take care and have a great day. Thanks, everybody.