Open Enrollment 2025: What Biologic Coordinators Need to Know

Oct 1, 2025

Open Enrollment 2025: What Biologic Coordinators Need to Know

By Brianna Pepin

Every fall, open enrollment season brings new challenges for patients and providers alike. For biologic coordinators, this is a critical time to prepare for coverage changes that can directly impact patient access to therapy. Whether your patients are on commercial insurance or Medicare, here are key reminders to help you navigate the season smoothly.

Know the Timelines Commercial Insurance:

Most employers hold open enrollment during the fall, typically October through December, with new plans taking effect January 1. Patients often assume their coverage will stay the same, but even small changes to formularies or specialty tiers can affect biologics.

Medicare

Annual enrollment runs October 15 to December 7, with new coverage beginning January 1. Medicare Advantage and Part D plans frequently update preferred drug lists, cost-sharing structures, and specialty pharmacy requirements.

Be Proactive with Patients

Encourage patients to review plan details early. Many patients don’t realize that switching from one plan to another—even staying with the same carrier—can mean new authorizations are required. A simple reminder call, portal message, or handout can save weeks of delay in January. Ask patients to: Provide new insurance cards as soon as they arrive. Verify that their biologic is still covered under the new plan. Ask if specialty pharmacy restrictions will change.

Anticipate Renewal Workloads

Open enrollment overlaps with annual prior authorization renewals. That means January can be one of the busiest months for coordinators. By beginning renewal work in November and December, you can prevent treatment gaps. A checklist that includes labs, updated chart notes, and insurance verification can streamline the process.

Special Considerations for Medicare

Medicare patients often face higher out-of-pocket costs for specialty medications, since most biologics fall under Part D plans and require coinsurance on the specialty tier. Starting in 2025, Medicare offers prescription payment plans that allow patients to spread out their cost-sharing across the year instead of paying a large amount all at once. Coordinators should be prepared to educate patients about how these payment plans work and how to enroll. In addition to Medicare’s payment smoothing option, patients may still benefit from manufacturer support programs, foundation assistance, or low-income subsidy (Extra Help) options. Even if they’ve used assistance before, they may need to reapply with each plan year. Helping patients understand all available resources can prevent cost from becoming a barrier to adherence.

Team Communication is Key Work closely with providers and staff to set expectations. Let them know that open enrollment can lead to delays and that proactive documentation is especially important this time of year. Clear communication ensures that patients don’t feel caught off guard by the insurance process.

The Bottom Line

Open enrollment is more than just paperwork—it’s a pivotal moment for ensuring patients stay on therapy without interruption. By planning ahead, keeping patients informed, and staying organized, biologic coordinators can turn a stressful season into a smooth transition. Remember: a little preparation in the fall saves a lot of frustration in the new year.

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At BC Educators, we are dedicated to empowering biologic coordinators, healthcare professionals, and patient advocates with the education, tools, and resources needed to optimize patient care. From expert-led webinars to hands-on training, we provide comprehensive support to help you navigate the ever-evolving landscape of specialty medications and prior authorizations.