Sponsored Content

Smart Part D Choices Could Improve Your Client's Health and Savings

By TJ Gibb, President, Medicare Part D, Humana

Choosing among health plan options can be overwhelming for people eligible for Medicare and a major reason they turn to professionals for help. This is especially true when it comes to prescription drug coverage. With hundreds of Part D prescription drug plans (PDPs) offered through private insurers in 2024, selecting prescription drug coverage could be one of the most consequential decisions your clients will make.

Almost all older Americans take at least one prescription drug and 36% are prescribed five or more different medications. Meanwhile, prescription drugs have accounted for about 20% of Medicare beneficiaries' out-of-pocket costs, which means the plan selected can have a substantial impact on both their physical and financial health. In fact, one in five older adults don't fill their prescriptions or they skip doses due to the cost of their medications, putting their health at risk and resulting in additional medical costs.

Selecting a PDP that offers access to affordable medications and makes the benefit easy to use is essential to your client's health and their satisfaction with the plan. You can assist your clients by helping them understand their medication needs and coverage options, as well as introducing them to the resources the plan provides once they're enrolled.

Assessing medication needs and access

It's neither good for your client's health nor for your relationship with them if they enroll in a plan that doesn't cover a necessary medication or the cost of their prescription drugs is prohibitive. To avoid that outcome, confirm their current medications are covered by the plan and also suggest that your client speak with their physician about potential health issues that could require a drug treatment in the coming year. Humana provides an Rx calculator that makes it easy for you to assess the anticipated out-of-pocket costs of your client's current and future medication needs under different plan options.

Formulary and network size counts

PDPs vary in terms of the number of drugs they cover in their formularies. Those with large formularies can be safer bets when unexpected medication needs arise, as well as provide more medication options that can help reduce out-of-pocket costs.

Easy access to medications is another important factor to consider to ensure members can easily obtain the medications they need. Having more than 60,000 pharmacies in Humana's network means PDP members across the country can almost always choose a convenient pharmacy in their plan's network. Additionally, many Humana PDPs provide access to preferred cost-sharing pharmacies that offer members reduced costs on many covered prescription drugs. Home delivery pharmacies, such as Humana's CenterWell Pharmacy™, may also be a cost-saving and convenient choice for members taking maintenance medications for chronic conditions when they order a 90-day supply, often at a lower copay than a 30-day supply.

Digital tools that make a difference

Adoption of healthcare technology has surged in recent years, and assessing PDP options and accessing resources using online digital tools can help your clients manage their medications and see pricing options that could help them save on their prescription drugs. For example, Humana's PDPs offer members an easy-to-use, personalized digital dashboard where they can use a real-time drug pricing tool to look for less expensive medication options, if available, as well as locate in-network pharmacies with the lowest cost-share. Another program, Maximize Your Benefit Rx, proactively alerts members through various online and offline channels when they've filled a prescription that has a less expensive option available to them.

You can add value by introducing your clients to the digital tools provided by their PDP and helping them make full use of these resources.

Assistance programs that help

If a client continues to struggle to afford their medications, they may be able to receive additional help from governmental and pharmaceutical assistance programs. About 22% of Medicare beneficiaries qualify for a  Low-income Subsidy (aka Extra Help), a federal program that can potentially save them thousands of dollars on their Part D costs by covering their premiums and out-of-pocket costs. Additionally, State Pharmaceutical Assistance Programs (SPAPs) are state-run programs that offer financial assistance for medications to eligible beneficiaries.

Pharmaceutical companies may also provide support to low-income people by lowering the cost of a drug or even providing it for free. However, this assistance is outside of Part D coverage and does not count toward the member's true out-of-pocket costs.

These programs may not be easy to access or navigate for your clients, so guiding them through this process will further establish you as a trusted and valuable resource.

Getting the support you need

Prescription drug care and Part D benefits can be complicated, but there are both online and offline resources to help your clients. Humana's digital resources for Humana agents include prescription drug calculators, enrollment tools, educational information and translation support in 20 languages. Additionally, a support team is available to you with boots-on-the-ground knowledge of your local community and your unique needs as a valued agent.

Among the health plan decisions your clients need to make, their PDP choice and how to best use their plan can have an outsized impact on their health and well-being. Providing your expert guidance and support will go a long way toward helping your clients live their happiest and healthiest lives.