Using the Medicare Advantage Over-the-Counter (OTC) Medicines Program as a Consumer Engagement Tool

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New Report: Using Medicare Advantage Over-the-Counter (OTC) Medicine Programs as a Consumer Engagement Tool

The Medicare Advantage health insurance market represents an attractive and rapidly growing opportunity in the Consumer Healthcare and OTC Medicines industry. As of 2021, nearly 18 million consumers have access to health-plan funded and administered OTC benefits with an average of $400 in OTC allowances per enrollee. This equates to a total of $7.1 billion in total allowances for OTC Medicines and other covered products. Most health plans, to date, have used their OTC benefits as a member acquisition tool, and, accordingly, utilization of OTC benefits is approximately 30% leaving nearly $5 billion in unused OTC allowances.

In a recent shift, health plans seeking new ways to retain enrollees, improve customer satisfaction, and identify new care management strategies are looking at OTC and other Supplemental Benefits as a tool since they provide numerous benefits to health plans, including the following:

  • Enrollees who use the OTC programs are those with greater healthcare need and are the same enrollees health plans seek to engage for other clinical and care management program
  • Certain populations see reduced medical costs and utilization, as well as improved outcomes for enrollees who use the OTC program (vs. those who do not)

This paradigm shift, paired with the data and evidence shown in studies like ours, creates an opportunity for consumer health organizations, OTC manufacturers, health plans, and policymakers to collaborate to take full advantage of the gains OTC programs provide.

View our on-demand webinar to hear from researchers Cary Badger and Zain Jafri (moderated by CHPA’s David Spangler) about results of the study with a deep dive into:

  • The basics of the Medicare Advantage marketplace
  • Findings from an analysis of one regional plan’s data on enrollees who used the OTC benefits vs. those who don’t
  • Opportunities for plans and how product manufacturers can engage with plans to help realize this potential

View Webinar

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