CMS to spread awareness of Rx payment plan through guidance

Photo: Willie B. Thomas/Getty Images

The Centers for Medicare and Medicaid Services this week released the final part two guidance regarding plan outreach and education for the Medicare Prescription Payment Plan, which aims to ensure that people with Medicare prescription drug coverage, especially those most likely to benefit, are aware of the payment option.

Starting in 2025, the Medicare Prescription Payment Plan provides the option to people with Medicare prescription drug coverage to spread the costs of their prescription drugs over the calendar year rather than paying in full at the pharmacy counter each time they fill a prescription. People with Medicare must opt into the Medicare Prescription Payment Plan to utilize the new benefit.

This payment option launches at the same time that everyone with Medicare prescription drug coverage will begin to have their annual out-of-pocket prescription drug costs capped at $2,000.

WHAT'S THE IMPACT?

CMS said the final part two guidance complements its forthcoming national education and outreach efforts to engage interested parties – including Part D plans, pharmacies, providers, drug manufacturers and beneficiary advocates – on program implementation.

The goal of this effort is to provide the support and materials necessary to determine who may benefit from the program and guidance on how to educate them about the new payment option. This guidance updates and finalizes requirements proposed in the draft part two guidance released in February 2024.

The guidance, which complements the final part one guidance released on February 29, is also accompanied by the release of the final Medicare Prescription Payment Plan model materials. Medicare Part D plans can use the model materials when communicating to Part D enrollees about the Medicare Prescription Payment Plan.

"The Medicare Prescription Payment Plan complements other important changes to prescription drug coverage within the Inflation Reduction Act, and we encourage people with Medicare prescription drug coverage to look at this payment option and our other programs, such as Extra Help, to see what is right for them," said Dr. Meena Seshamani, CMS deputy administrator and director of the Center for Medicare.

THE LARGER TREND

CMS took the opportunity to tout some of the benefits of the Inflation Reduction Act, which to date has capped out-of-pocket costs for a month's supply of each covered insulin product at $35, and made Advisory Committee on Immunization Practices-recommended vaccines available at no cost for people with Medicare prescription drug coverage.

According to the federal agency, the IRA also expanded eligibility for the Extra Help program under Medicare Part D, which provides prescription drug coverage with no deductible, no premiums, and fixed, lowered copayments for certain medications to certain individuals.

And as of January 1, some enrollees now have their out-of-pocket drug costs capped at about $3,500. Additional savings arrive in 2025 when yearly Part D out-of-pocket costs will be capped at $2,000, said CMS.
 

Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.