Medicare beneficiaries get prescription payment plan under new draft guidance
The new program would allow for monthly payments over a year.
Photo: Terry Vine/Getty Images
The Centers for Medicare and Medicaid Services has released draft guidance that would allow Medicare beneficiaries to pay for prescription drug coverage in monthly payments spread out over a year.
The Medicare Prescription Payment Plan option would start in 2025.
The program aims to reduce the burden of high upfront out-of-pocket prescription drug costs.
WHY THIS MATTERS
Given the size of the new program, CMS is releasing the guidance in two parts. Additional draft guidance is expected to be released for comment in early 2024.
The first draft guidance, released Monday, focuses on helping Medicare Part D plan sponsors and pharmacies prepare for the new program and build the necessary infrastructure for successful implementation. The draft guidance provides information on topics such as identifying Medicare Part D enrollees likely to benefit from the program, the opt-in process for Part D enrollees, program participant protections and the data collection needed to evaluate the program.
CMS is seeking comment on these topics and on strategies to help ensure eligible Part D enrollees benefit from programs like the Medicare Savings Programs and Extra Help to lower their out-of-pocket prescription drug costs.
The comment period is open for 30 days. Comments received by September 20 will be considered during development of the final guidance. CMS anticipates issuing final part one guidance in early 2024.
The second part of the guidance will focus on Medicare Part D enrollee outreach and education, Medicare Part D plan bid information, and monitoring and compliance. CMS also intends to develop tools, such as calculators, to help people with Medicare Part D and their caregivers learn what monthly payments may look like under the new program.
THE LARGER TREND
The actions implement prescription drug policies of the Inflation Reduction Act.
In August 2022, the bill barely passed the Senate in a 51-50 vote, with Vice President Kamala Harris as the tie-breaker.
The Inflation Reduction Act allows Medicare to negotiate drug prices for the first time for 10 high-cost drugs. It keeps drug prices in Medicare from rising faster than inflation and puts a $35 monthly cap on insulin for Medicare beneficiaries.
Pharmaceutical executives have spoken out against the law, saying it has the consequence of limiting investment in new drugs at a time when the science is there to innovate.
ON THE RECORD
"People with Medicare are already feeling the benefits of the prescription drug law – such as free recommended vaccines and lower costs for insulin," said CMS Administrator Chiquita Brooks-LaSure.
"The new Medicare Prescription Payment Plan helps those who struggle the most with high upfront prescription drug costs and provides a way to ensure people with Medicare can get the life-saving medications they need," said Dr. Meena Seshamani, CMS deputy administrator and director of the Center for Medicare. "Public feedback, both through comments on this draft guidance and extensive engagement, continues to be instrumental in the implementation of the prescription drug law and delivering on the promise of more affordable drugs for people with Medicare."
Twitter: @SusanJMorse
Email the writer: SMorse@himss.org
