Tag Archives: Jason Gomberg

Medicare Part D member profitability by pharmacy channel

Preferred networks have become the norm in the Medicare Part D landscape. Members typically have a lower cost-sharing requirement when they use a pharmacy in the preferred network. Preferred pharmacies expect to receive a greater share of the carrier’s business and provide the carrier with greater discounts or direct/indirect remuneration (DIR). In this research paper, Milliman’s Jason Gomberg and Michael Hunter analyze 2014 Part D plan profitability to determine if specific pharmacy channels are associated with members that may be more or less profitable for a Medicare Part D carrier.