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Patient response to changes in available Medicare Part D coverage plans: A case study
Background:
Medicare Part D provides prescription coverage for Medicare beneficiaries. Community pharmacies dispense a substantial share of Part D prescriptions but face growing financial strain because pharmacy benefit manager reimbursement rates can be less than acquisition and operating costs. Community pharmacies can choose not to accept an insurance plan, though this has implications for patient access and pharmacy revenue.
Objective:
The purpose of this study is to determine patient behavior changes in relation to a community pharmacy's decision to no longer accept certain Medicare Part D plans.
Methods:
A retrospective analysis was conducted to evaluate patterns after a notice letter was sent to beneficiaries specifying which plans will be accepted and not accepted in 2026. The data focused on Medicare Part D plans from 2025 to 2026 and further broken down by accepted or nonaccepted plans. The study evaluated participants continuing to purchase prescriptions at the community pharmacy despite having a nonaccepted Medicare Part D plan.
Results:
A total of 119 participants were included in the analysis, and 61 participants (51.26%) switched their Medicare Part D plan while 58 (48.74%) remained on the same plan from 2025. However, 80 (67.23%) continued to use the community pharmacy, with 10 patients having pre-existing accepted secondary plans, and 12 continued to obtain prescriptions at the pharmacy despite their Medicare Part D plan not being accepted. Twenty-three (19.33%) patients who did not have an accepted plan in 2026 transferred prescriptions to a different pharmacy.
Conclusion:
This study evaluated Medicare Part D plan switching in relation to a community pharmacy's decision to no longer accept certain Medicare Part D plans during open enrollment. Medicare Part D plan switch rates were higher than national estimates. Clear communication may decrease loss of patients when a community pharmacy chooses to no longer accept a Medicare Part D plan.
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