Expert Discusses Survey Results Finding That Pharmacists Are Concerned About Losing Medicare-Eligible Patients

At the National Association of Chain Drug Stores (NACDS) 2022 Total Store Expo, Pharmacy Times spoke with Danny Sanchez, senior vice president and general manager of EnlivenHealth, to learn more about a recent survey which found that pharmacists are very concerned about losing Medicare-eligible patients when they switch Medicare plans. Sanchez said that although pharmacists can play a role in educating patients about Medicare plan options, staffing problems can limit their ability to do so.

Q: A survey from EnlivenHealth found that the majority of retail pharmacists worry about losing Medicare-eligible patients when they change plans. Why does this loss happen?

Danny Sanchez: Yeah, so every year Medicare patients are eligible for open enrollment, right? So, this is a period of the year where patients can go out and pick new plans, so it does give the opportunity for plans to go and take patients from other plans. And so, the danger there is that if you're a retail pharmacy and you have your patient population, and they move into a plan that you don't serve, you lose those patients, right? So that's a risk. And now, we recently did a survey and the survey called out to us that, you know, one-third of patients, on average, at a retail pharmacy are Medicare patients. So, it's a substantial number of patients that [pharmacies] are at risk of losing or moving to a different pharmacy.

Q: What potential financial impact does that have on retail pharmacies?

Danny Sanchez: Yeah, it is, it is a material impact to a retail pharmacy. You know, [number] one, these patients are what we call poly-med patients, and most of them are taking many medications, right? So, prescription rich patients, even though they're one-third of the population of patients going into that pharmacy, now they comprise a large portion of that profit and loss for that pharmacy, right? So, the impact is if you lose these patients, how do you backfill these patients? Right?

And, you know, there's also a patient satisfaction perspective here. If you lose a patient, the patient goes to another pharmacy, and all of a sudden now they don't have their trusted pharmacist. And, as you know, pharmacists are the second most trusted health care professionals. You know, you lose access to that professional who knows your background, who knows your health profile.

Q: In addition to that financial impact, changing plans can impact patients’ care with their pharmacist. Can you discuss how this impacts patients?

Danny Sanchez: Yeah, totally. I think sometimes it's underestimated, the role that pharmacists play, and now a broader role, right? It's kind of as pharmacy evolves into this next gen, more of a care environment. You know, pharmacists help not just with dispensing medications, they help talk to a patient about their medications, how they should be taking their medications, if they feel like a prescription is not properly prescribed for a patient, they intervene, they reach out to their doctor, so knowing your patient is a big deal, right? So, if a patient moves off to another pharmacy, all of a sudden you have to rebuild that relationship from zero. And that's not good for either the pharmacist or the patient. The pharmacist now has to learn that patient, and the patient, again, is at a disadvantage because they're starting from zero, right?

Q: How can pharmacies retain their Medicare-eligible patients?

Danny Sanchez: Yeah, so, I mean, the great thing is EnlivenHealth has a really good tool to help look at a patient's profile. So, look at their drug regimen, look at their prescribers, and then recommend a plan that's best for them. And that's a big deal, because if you look at the market today, what happens frequently is during this open enrollment period, plans are just reaching out to seniors without any kind of data, and just saying, enroll in our plan. I recently visited a diner, and when I stepped out of that diner, there was an enrollment table there with a young lady enrolling patients. And I asked them questions, and she had no data on these patients except she was giving them a back scratcher and trying to enroll them in their plan. Now how good is that for a senior, right? It's a terrible, terrible way to enroll a patient. EnlivenHealth has a solution that looks at a patient's medications, looks at their physicians, and then recommends the best plan for that patient. We also weigh in the fact that,
“Hey, do you want to stay at this pharmacy?” and we weigh that piece as well. So, we're able to take all these elements and then recommend the best plan for the patient. And that's a huge, huge differentiator in the market. We're not trying to drive a patient to a plan. We're trying to recommend the best plan for that patient.

Q: Helping patients select and manage their Medicare plan is important and is an opportunity for pharmacists, but the survey also found that staffing limits their ability to do so. Can you discuss this finding?

Danny Sanchez: Yeah, I mean, staffing is a problem in retail. As we see more services moving into retail pharmacy, staffing does become a problem. EnlivenHealth offers all kinds of solutions to help with the staffing piece, one being just digitizing your engagement, right? Being able to message your patients, being able to engage them through automation, so that they're not having to come into the pharmacy as often, or even when they call in, they're able to solve a lot of their problems within our technology. And if I have to speak to a pharmacist, if you walk into any pharmacy at 6pm, you'll see that pharmacists are on the phone, literally with the phone stuck to their ear, trying to triage questions, trying to just get through the volume of patients coming in at that time. You know, our mission is to reduce that. We want to free the pharmacists from those mundane tasks so they can go work on these more value-added services that really do improve health.

Q: Are there any legislative efforts tackling these issues?

Danny Sanchez: In 2022, there's been over 150 bills introduced to help drive change and to help expand the scope of practice for pharmacists, [and] about a third of those have passed in 2022. And the momentum continues. So, I think society is seeing, and our legislature and our regulators are seeing that, you know, there's more opportunity for pharmacists, that they can do more. And frankly, it's the footprint. It's the caliber of what a pharmacist can do. You have a very underutilized health care professional, and we want to maximize them, right? We want to move more services. So, there's a lot of regulation going through. I'm happy to say that some of these bills have bipartisan support, because you need bipartisan support to get these things through, and we're going to see more expanded capabilities for pharmacists in the future.

Q: Is there anything you would like to add?

Danny Sanchez: Yeah. I mean, I think that, you know, I'm really excited the direction we're going. EnlivenHealth is freeing the pharmacist, right, enabling the pharmacist to move off of the mundane, as I mentioned, using our technology, and then we're bringing solutions that are helping them evolve into this next generation. Gone are the days where pharmacists are just filling prescriptions. If you're just a pharmacy filling prescriptions, you will not survive this, right? It's not a good thing. You should be turning the corner and providing other solutions, other health care opportunities, and that's what EnlivenHealth does—it empowers you to really modify and change your business, and so I'm excited to be able to lead that effort.