Introducing Third-Party Mastery

In my previous blogs, I’ve posted about how I view the ideal pharmacist in the current pharmacy market as a cross between a clinician, a retailer and an insurance navigator. Pharmacists go through 4 years of pharmacy school to become great clinicians that understand the theory and practice of drug therapy selection and optimization.

Want Third-Party Mastery in your pharmacy before January 1? Join the early adopter waitlist.

No one really teaches pharmacists the “business side” of the pharmacy in direct instruction, and so if you pay attention, you learn over time how pharmacy benefit managers work, what Medicare Part D is, what Medicaid Managed Care and Medicaid Fee for Service are, and what a deductible is, how copays come to be, what coinsurance is, why a drug has a prior authorization and so on and so forth - learning how to be the insurance navigator.

You also learn pretty quickly that no matter how good your theoretical knowledge of therapeutics are, you can’t do much for your patients if you don’t have the drugs on the shelf to be able to actually deliver the pharmaceutical part of pharmaceutical care. So you start learning about inventory management, payment terms, cycle counts, and you obsess over the returns policies of your suppliers so that you can balance keeping drugs in stock for your patients with keeping money in your bank account to pay all of your other expenses.

Over the past 7 years I have devoted an enormous amount of time to figuring out Medicare Part D, and I’ve developed a system for displaying relevant plan information in my software. I’ve helped hundreds of pharmacies to implement the same system over that time, but the system I implemented required a ton of manual data entry by me and then even more work by the pharmacy staff to ensure correct patient-plan matching. But when implemented fully, this system allows pharmacists to actually be the insurance navigator that their patients expect them to be. “Why is my copay $X?” is a super frequent question in the pharmacy, and with Third-Party Mastery, pharmacists and technicians can answer this question with precision and clarity, rather than saying “I dunno, call your insurance company and ask them?”

Third-Party Mastery is a module in Raichel, the software I’ve built with my partners Joe Williams and Neal Smoller at my new company, PharmacyAI. Raichel works inside your pharmacy system the way a great tech does, and she automates an enormous amount of work that makes pharmacies run more cleanly, efficiently and effectively. In Third-Party Mastery, Raichel will standardize the pharmacy’s third party plan tables to match 1:1 with the Medicare Part D Plans and Medicare Advantage plans offered in the pharmacy’s service area. It will then match all of the Medicare beneficiaries to their current plan, and display in workflow detailed information about the plan’s formulary structure, including deductible, exemptions, and tiering, as well as any differential copays for preferred vs. standard vs. mail order pharmacy networks so that pharmacists can have frank and accurate conversations about how the plan works.

Crucially, it automatically performs a matching process to each patient’s plan at the beginning of each new contract year, allowing pharmacy staff to walk in the door on January 1 or 2 and know that their Medicare patients’ claims will process cleanly against their CY2027 plans. No more “sorry we need a new card” or “I dunno, probably you have a deductible” - just cleanly processed prescriptions with clear and accurate plan benefit design information at your fingertips.

Do you want Third-Party Mastery now? Sign up for our early adopter waitlist: pharmacyai.com/early-adopter

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