1. How many times can I switch my patient's 2016 Part D plan during this Open Enrollment period?
You can switch 2016 plans for your patient as many times as you need throughout the Open Enrollment period, October 15, 2015 through December 7, 2015.
2. Why is my patient is only showing their drug list from 2015 when I click on their name?
If you haven't imported your patient on iMedicare since last Open Enrollment, it is likely that their drug list is not up to date if their drug regimen has changed. To get an updated list, simply re-import the patient by click on the green "Import" button and searching your patient's first and last name.
Tip: Be sure to transfer useful information over to the new profile (like their current plan and current subsidy), if you have that information loaded on their profile from last year.
3. What if my patient is dual eligible status? Will iMedicare reflect this in its pricing?
Absolutely! Once you are on the patient's profile on iMedicare, click the green "Edit" button on the top right-hand corner. This will bring down the "Subsidy" dropdown menu, where you can manually input the patient's current subsidy.
Tip: Look back into your pharmacy system to match up their co-pays to the subsidy options if you do not remember which subsidy they are on.
4. I entered my patient's dual eligible status in, but plans with premiums are still populating? Is this possible?
This is not a mistake. Even patients who are dual eligible will sometimes have to pay a monthly premium on certain plans. Medicaid is willing to pay a certain amount toward premiums. This number changes from state to state. If the plan has a premium that’s larger than this “benchmark”, the patient pays the difference.
5. When I am looking at the report that printed out for a patient there is a column that is labeled Full Cost. What exactly does the number in that column mean?
This number represents how much money is coming back to the pharmacy through co-pays and reimbursements. Co-Pay + Reimbursement = Full Cost of the Drug. Since most plans offer zero coverage before the deductible is met, patients usually pay the full cost of the drug until the deductible is met.
6. I notice there is a restriction on a drug on one of my plans. How can I find out which drug it is?
When looking at the monthly breakdown page, you can select a month to expand it. Here, you will see that some drugs are highlighted in yellow or red. This means there is a restriction in place on that drug or it is not covered at all under that plan's formulary. To find out more, click on the drug to pull up the drug profile, and the restriction abbreviation will be to the right of restrictions.
Yellow = Restriction in place (ST, PA, or QL)
Red = Not covered
7. Why do my patient's drugs have zero dollar copays in the deductible phase in WellCare plans?
WellCare is offering pre-deductible coverage on certain tier 1 generics. This is a rare occurrence. It benefits patients by offering cheaper copays. It also benefits the plan providers, because it incentivizes the use of less expensive prescriptions.
8. My patients are only showing drugs for the months of November and December. What's going on?
You are probably looking at the plan pricing "starting today". If you click the options button on the "View and compare" page, and unselect "calculate starting today", you will get the monthly breakdown for the entire year.