Webinar Summary: Don't Wait, Migrate: How to Navigate Network Exits & Retain Patients with Medicare Plan Comparisons

The webinar, "Don't Wait, Migrate: How to Navigate Network Exits and Retain Patients with Medicare Plan Comparisons," hosted by EnlivenHealth, provided critical insights into the shifting Medicare landscape and strategies for independent pharmacies to adapt and thrive amidst industry changes.

Featuring the expertise of Marvin Guardado (Head of EnlivenHealth’s Solution Sales and Strategy Team for EnlivenHealth Match) and Joe Williams, PharmD (independent pharmacy owner and co-founder of Apex Pharmacy Consultant), this session was a must-attend for pharmacy professionals aiming to retain patients despite network exits and changing plans.

Why This Webinar Matters

Medicare is undergoing significant changes, triggered in part by legislative shifts such as the Inflation Reduction Act. Network exits, carrier pullbacks, and rising premiums are pushing independent pharmacies to reconsider their roles in patient care. This webinar explored how pharmacies can use Medicare plan comparisons as valuable tools to navigate these industry challenges, retain patients, and grow their clinical service offerings.

Introducing the Speakers

Marvin Guardado: As the Head of Solution Sales & Strategy at EnlivenHealth, Marvin ensures pharmacy teams can succeed using digital tools to create meaningful patient engagement and profit opportunities.

"At our core, our mission is simple. It's to put pharmacy teams at the center of care by building digital tools that improve patient care, strengthen population health, and grow in a sustainable way."

Joe Williams, PharmD: With his decades of experience as an independent pharmacy owner and co-founder of Apex Pharmacy Consulting, Joe employs a practical, values-driven approach to every stage of pharmacy advocacy and ownership. His firsthand insights into managing evolving networks provided grounded and relatable guidance.

"It always comes back to sustainability: if you're not sustainable, you're not going to be there for the next generation or the next five years."

Major Changes in Medicare Networks: Challenges and Opportunities

Marvin opened the session by addressing sweeping changes in the Medicare ecosystem. Network exits and carrier consolidations are creating gaps in communication, presenting independent pharmacies with a unique opportunity to fill those voids and reinforce their relationships with patients. "Carriers are pulling back in the number of plans that they’re going to offer next year,” said Marvin. “PSAOs are leaving networks, creating a real opportunity for pharmacies to step in."

Marvin then shared Warren Buffett’s iconic advice: "Be fearful when others are greedy, and be greedy when others are fearful." Pharmacies should approach these changes with confidence and strategic action, not fear.

The Impact of Medicare Advantage and Premium Changes

Recent trends are reshaping the future for pharmacies. Policymakers are pushing patients toward Medicare Advantage Prescription Drug (MAPD) plans, incentivizing patients with affordable premiums and increased benefits. Plus, changes like the $2,000 out-of-pocket cap (rising to $2,100 by 2026) are reducing patients’ financial burden but increasing costs for carriers.

Meanwhile, a number of carriers are exiting markets because they’re no longer profitable. Marvin referenced Sonder Health Plan’s insolvency in Georgia and UnitedHealth cutting plans for 600,000 Medicare Advantage members. Even in these situations, pharmacists have an opportunity to provide informed advice and position themselves as trusted advocates for their patients.

Navigating Network Decisions and Patient Education

Pharmacies face declining reimbursement rates and fewer network options as PSAOs reject large Medicare networks. Joe emphasized evaluating reimbursement margins to determine whether to stay in a network or opt out, saying, "If you're not sustainable, you're not going to be there for your community in the long run."

While stepping away from certain networks may be necessary, pharmacies must control the narrative with patients. "You don't want the first notification to your patient that you're no longer contracted to come from the PBM," Joe warned.

Both speakers agreed that direct communication and proactive engagement—including reaching out to patients via phone calls, text message campaigns, and emails—are essential for patient retention.

Leveraging Tools for Plan Comparisons and Patient Retention

Both speakers highlighted the importance of EnlivenHealth Match as a strategic tool. Medicare plan reviews are more than administrative—they’re powerful ways to build patient trust, generate referrals, and foster long-term loyalty.

“Plan comparisons are a marketing strategy,” said Joe. “Once a week, we’d get a phone call or a new patient from those referrals."

Plus, tools like EnlivenHealth Match allow scalability and integration, reducing the burden of manual processes. "When you can have software that organizes that data, it’s really invaluable," added Joe.

Becoming a Licensed Insurance Agent: Path and Benefits

Pharmacies that wish to deepen their involvement should consider becoming licensed to sell Medicare plans. Joe shared his experience:

"I had to lock myself in a room, take the necessary study hours, pass the exams, and contract with carriers. It was a long-term commitment, but it was worth it."

While licensing is time-intensive, hybrid models and partnerships can help smaller pharmacies ease into the process. In the end, Joe summed it up when he said, “You definitely shouldn’t be doing nothing. Create a plan, initiate it, and do it sooner rather than later.”

Closing Remarks and Takeaways

Both speakers underscored the importance of seizing this moment of industry flux to strengthen patient connections, diversify services, and grow sustainably. Pharmacies that adapt with technology and strategic planning can survive—and thrive—amid Medicare changes.

If you haven’t already, consider attending EnlivenHealth’s guided walkthroughs and webinars to maximize your pharmacy’s impact during open enrollment. As Marvin eloquently stated:

"If your pharmacy is not part of the conversation, someone else gladly will be—and they don’t know your patients like you do."

To watch the webinar in full, click here.

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