Medicare Advantage Rules Regarding Prescriptions

[Cenla Agent]

You are doing an injustice sending your customer to the pharmacist. I worked pharmacy for many many years and the first company to get hold of the pharmacy and get them to come on board with their card, give them a kickback for each application enrolled is who they point them to.
I did drug cards in the pharmacy long before I got licensed and I was told to sell the ccrx card, signed over 200 customers and the pharmacist got a nice check and I got jack sh**.
I sit with the customer, get this list of drugs, do some research (which is our job if you care about your customers) and find them the best drug card available.
I have made many happy repeat customers just taking the time to help them, my annuity business is doing well because they now trust me with the small stuff.

I tend to agree with this, unless you know the pharmacist. Not all of them are like the one in the above example, but I wouldn't just blindly refer them to "your pharmacist" unless you know something about them. Referring them to 1-800-Medicare or the Council on Aging would be better options. While there are exceptions, the majority of pharmacists are too busy to be able to give unbiased advice. (The best way to do that is to plug their information into Medicare.gov.) Many pharmacies are also pushing a particular plan. Some others who aren't may not want to get involved lest they be blamed if something goes wrong that is outside of their control.

I have heard of some exceptions, of some doing what Frank notes, but this will typically be slower paced pharmacies, often in more rural areas. If I'm not mistaken Walgreens was giving advice on what the best plan was based on the customer's rx info. But most others, especially the chains, were pushing one plan or another. As Penny noted, when the Part D floodgates opened in 2005-2006 a lot of the smaller indep. pharmacies were tied win with CCRX, which was typically not a very good choice. (However, I haven't dealt much with Part D in the past year, it could be a very competitive plan now for all I know. Humana was the best back then in almost every case but appears to be pretty uncompetitive now.)

For many seniors, their Rx costs are the #1 concern in their mind, moreso than Med Supp in some cases, because of how much they spend every month. Some really do their homework and will enroll online or over the phone, but others will look to the agent for advice. The agent who is willing to take care of all of these issues and who has the client's best interest at heart will often get the business.

I'm not alleging that those who don't sell Part D don't have the client's best interest at heart, only that you may lose some Medicare Supplement business along the way to an agent who does sell it, particularly to the type of client who prefers to deal with one agent instead of having a different agent for every policy.

 

[MedSuppPro]

If we go back to the regulations and re-read them, "CARRIERS" are forbidden to cherry pick. Carriers are correct in instructing their captives of this rule. However, independent agents are doing what we do best -- shop-the-market. We are simply doing our DUE DILIGENCE. Ask yourself what is the intent of this regulation. We may all draw our own conclusions…

I do what is best for my client. I'll do a complete CMS drug lookup and then give them my recommendation regardless of carrier. This means referring them to the best PartD plan. This demonstrates integrity…

If the referred carrier has aggressive agent force (i.e. inHumane), then I give them the 1800Medicare number. If my client is difficult to please, then I'll give them over to the pharmacy. I pay close attention to who their pharmacy is so as not to lose a client to a pharmacy whom refers client's out to other agents. Yes, this does happen… Likewise if a pharmacy dinks me I start educating the client about mail order or shopping around.

I get a lot of referral business because I do drug lookups.

​