BEVERLY NEAL-CLINTON
Retirement Answer Team
Loreen & Green

Editor’s note: This article is not written in my Ms Clinton’s capacity as a Councilor-elect. It is solely written in her capacity as part of the Retirement Answer Team.

If you’ve recently lost your Medicare coverage under Aetna, Humana 341, Presbyterian PPO, Wellcare, United CSNP, or simply due to a plan discontinuance, you may qualify for a Special Election Period (SEP), allowing you to make changes to your plan outside the regular enrollment windows.  Beginning in January

This SEP can be a lifeline for those who’ve experienced a qualifying event such as marriage, divorce, the death of a spouse, an employer settlement payment, losing employer-based insurance, changes in income, changes in residence, changes in employment or moving out of their plan’s service area.

Navigating the complexities of Medicare can be overwhelming.  As part of the Retirement Answer Team  who is a licensed and bonded broker, we can guide you through your options and help you enroll in a plan that meets your healthcare needs. Don’t wait until it’s too late—reach out to us today to explore your eligibility for the SEP and avoid coverage gaps.

The new changes to Medicare Part D are expected to have several key impacts on pharmacies, particularly in terms of reimbursement, drug pricing, and the way prescription drugs are dispensed. Here’s how local pharmacies may be affected:

1. Reduced Out-of-Pocket Costs for Beneficiaries: One of the biggest changes is the cap on out-of-pocket spending for Medicare Part D beneficiaries. In 2024, the cap will be set at $2,000. This could lead to more frequent visits to pharmacies by beneficiaries who need to refill prescriptions. Pharmacies will need to ensure they have systems in place to handle these changes efficiently.
2. Negotiation of Drug Prices: The new legislation empowers Medicare to negotiate the prices of certain high-cost drugs. This could result in lower reimbursements to pharmacies for those drugs, depending on the negotiated price. Pharmacies will need to adapt to changes in reimbursement rates, which may impact their financial operations.
3. Insulin Cost Reduction: A key change is the cap on insulin costs for Medicare beneficiaries, set at $35 per month. Pharmacies will need to ensure that insulin pricing is correctly reflected, and they may experience a higher demand for insulin prescriptions.
4. Impact on Pharmacy Benefit Managers (PBMs): The changes may lead to increased scrutiny of PBMs, which play a significant role in determining the drugs covered under Part D and the reimbursement rates. This could alter the dynamics of pharmacy reimbursements, as pharmacies may see changes in how they negotiate with PBMs.
5. Simplified Formularies and Drug Lists: Medicare Part D is streamlining formularies, which means fewer changes to the covered drugs list mid-year. Pharmacies will benefit from more stability in the drugs covered under Medicare, reducing confusion for both beneficiaries and pharmacy staff.

Overall, while pharmacies will also likely see increased demand for prescriptions and improved clarity in the Medicare Part D system, adapting to these changes will be essential for pharmacies to ensure that Medicare beneficiaries receive the medications they need.

It’s also important to stay informed about your personal health data. Recently, GoodRx was involved in a HIPAA violation, underscoring the need to protect your medical information. Trust only reliable sources with your data.