Selling MA Plans to my Rx Pts.

[insRX]

Stumble upon this forum as I was digging for information. I currently work in a pharmacy and over the years have gave out free information to my struggling patients. I am fairly knowledgeable about insurances and their processes and have referred many of my patients to "agents" and even had agents convince me to setup shop in my pharmacy to pitch their plans. That being said I did a little bit of research and decided to join in on the fun (money) and am looking to get licensed in California. After an hour research I came up with; signing up for the 52 hour Life, Accident, Health & Disability online course. Then take the test, get insurance and get setup with insurance plans to sell. Still not sure if this is all I need but its a start.

With all that being said; being in the pharmacy industry I know there are a lot of regulations. I am not sure if this is a conflict of interest or not but, can I legally "sell" insurance to my patients (own the pharmacy). I have a steady traffic flow of potential clients and have a large network of doctors that could help me out as well. I know each plan can give you a decent return, wouldn't hurt to make a few extra bucks.

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Anybody have any information on this topic?

 

[sman]

Stumble upon this forum as I was digging for information. I currently work in a pharmacy and over the years have gave out free information to my struggling patients. I am fairly knowledgeable about insurances and their processes and have referred many of my patients to "agents" and even had agents convince me to setup shop in my pharmacy to pitch their plans. That being said I did a little bit of research and decided to join in on the fun (money) and am looking to get licensed in California. After an hour research I came up with; signing up for the 52 hour Life, Accident, Health & Disability online course. Then take the test, get insurance and get setup with insurance plans to sell. Still not sure if this is all I need but its a start. With all that being said; being in the pharmacy industry I know there are a lot of regulations. I am not sure if this is a conflict of interest or not but, can I legally "sell" insurance to my patients (own the pharmacy). I have a steady traffic flow of potential clients and have a large network of doctors that could help me out as well. I know each plan can give you a decent return, wouldn't hurt to make a few extra bucks. ---------- Anybody have any information on this topic?

The biggest issue is that you wouldn't be able to set up shop in the pharmacy section. So that may make it difficult to fill someone's prescription and then transition to a Medicare Advantage plan recommendation.

If a complaint were made and the beneficiary states "my pharmacist enrolled me in the plan" that could cause some serious issues.

I'd recommend talking with a few carriers before proceeding.

 

[insRX]

It'll be an easy transition to take them into our consultation section and discuss matters with them or possibly setting up an appt. for an after hour visit to their home. Does this sound "legal"?

I just had an agent call me about possibly setting up a few times per month for open enrollment. He said he has to notify CMS prior to coming in to "sell" policies. He also stated that he is not allowed to call his clients that they have to make the first point of contact. Does this sound correct?

 

[GreenSky]

It's an easier transition to losing the pharmacy license as well as the insurance license for a conflict of interest.

Rick

 

[unic.consulting]

I come from the same general background as you, (I didn't get my license until I left pharmacy, but I brought a lot of my patients with me), so let me point out some problems that may arise for you.

1) You can't bring up Medicare Advantage or Prescription Drug Plans to the patients. They have to mention it first. Then you will have to have them fill out a SOA form and come back after at least 48 hours to actually meet with you.

2) Even if your pharmacy doesn't take a specific plan, you will have to present it on equal measure to the ones that your pharmacy offers.

3) You can't use the consultation room at the pharmacy. "If pharmacy counter area is located within a retail store, space outside of where patients wait for
services or interact with pharmacy provider and obtain medications (approximately 20 ft) " (courtesy Coventry Medicare)

If you're still eager to do this, the best option would be to create some CMS compliant brochures (Your FMO can help with this), put them in the waiting room, and set up meetings at a neutral location or the client's house.

 

[DS4]

I currently work in a pharmacy....

In my town, we probably have 20 pharmacies. Every single on of these pharmacies is slammed all day long. The pharmacists and techs barely have time to pee and eat lunch.
Are you aware of how much time is required to get licensed, trained, certified, and appointed?

 

[GreenSky]

In my town, we probably have 20 pharmacies. Every single on of these pharmacies is slammed all day long. The pharmacists and techs barely have time to pee and eat lunch.
Are you aware of how much time is required to get licensed, trained, certified, and appointed?

You need to be licensed, certified AND appointed? And what's this about training?

I am good with the eating lunch part though.

Rick

 

[sman]

I am good with the eating lunch part though.

Rick

I can attest to the fact that Rick is good with eating. Just don't put your hands anywhere near his face or you could lose a finger.

 

[yogooglethis]

Stumble upon this forum as I was digging for information. I currently work in a pharmacy and over the years have gave out free information to my struggling patients. I am fairly knowledgeable about insurances and their processes and have referred many of my patients to "agents" and even had agents convince me to setup shop in my pharmacy to pitch their plans. That being said I did a little bit of research and decided to join in on the fun (money) and am looking to get licensed in California. After an hour research I came up with; signing up for the 52 hour Life, Accident, Health & Disability online course. Then take the test, get insurance and get setup with insurance plans to sell. Still not sure if this is all I need but its a start.

With all that being said; being in the pharmacy industry I know there are a lot of regulations. I am not sure if this is a conflict of interest or not but, can I legally "sell" insurance to my patients (own the pharmacy). I have a steady traffic flow of potential clients and have a large network of doctors that could help me out as well. I know each plan can give you a decent return, wouldn't hurt to make a few extra bucks.

----------

Anybody have any information on this topic?

Let me put things in perspective about compliant initial contact with MA and PDP prospects.Agents who cold call for med supps and are also appointed with an MA/PDP carrier are on thin ice with CMS when these cold calls for MA are converted to MA/PDP sales.Be careful who you strike up a conversation with if you sell MA/PDP because CMS considers any systematic marketing approach that is seen as a method to evade the initial contact rules as bait and switch tactics.

The conflict of interest issue aside just the fact that a MA agent who is also a pharmacist know that their customers are going to ask about PDP can be construed as a bait and switch tactic. Now your position as a pharmacist is seen as a method to generate non compliant leads.It is very easy to get away with this until you don't so IMHO it's best to stay off that slippery slope

 

[EltonHCP]

InsRx,

I am a pharmacist myself (although haven't worked in one since 1/11/1997 - one of the better days in my life as I walked away from a certain VA.) You don't want to get yourself in a situation where you become a banned person from Medicare. You will not be able to do business with "any" PBM with "any" kind of government business. This means all of them.

I would say go ahead and take your exams and get appointed, etc, go through the certifications, and then re-evaluate how you can actually proceed based on the information you learned. You must identify yourself as a "sales agent" and not a "pharmacist" if you want to be in this line of business.