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Patient response to changes in available Medicare Part D coverage plans: A case study.
Tyler S Dougherty1, Krishna Mahida1, Elizabeth Nguyen1
1South College School of Pharmacy Knoxville, Tennessee.
Summary
When community pharmacies stop accepting certain Medicare Part D plans, many patients switch plans. Clear communication from pharmacies can help retain patients despite these changes.
Area of Science:
- Health Economics
- Pharmacy Practice
- Patient Behavior Analysis
Background:
- Medicare Part D offers prescription drug coverage to beneficiaries.
- Community pharmacies face financial challenges due to low reimbursement rates from pharmacy benefit managers.
- Pharmacies may opt out of certain plans, impacting patient access and revenue.
Purpose of the Study:
- To analyze patient behavioral shifts when a community pharmacy discontinues acceptance of specific Medicare Part D plans.
- To understand the impact of pharmacy decisions on patient plan selection and pharmacy utilization.
Main Methods:
- Retrospective analysis of Medicare Part D plan data from 2025-2026.
- Evaluation of patient prescription purchasing patterns after notification of non-accepted plans.
- Comparison of patient behavior for accepted versus non-accepted Medicare Part D plans.
Main Results:
- Over half of participants (51.26%) switched Medicare Part D plans.
- A majority of patients (67.23%) continued using the community pharmacy, even with non-accepted plans.
- 19.33% of patients whose plans were not accepted transferred their prescriptions elsewhere.
Conclusions:
- Medicare Part D plan switching rates exceeded national averages following pharmacy decisions to drop certain plans.
- Effective communication strategies can mitigate patient loss during open enrollment periods.
- Pharmacy decisions on plan acceptance significantly influence patient choices and pharmacy patronage.
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