CMS has introduced preliminary guidelines outlining a program for Medicare Part D beneficiaries to evenly distribute prescription costs over a year. The draft highlights methods for Part D plans to administer the Medicare Prescription Payment Plan and identify potential beneficiaries. Starting in 2025, beneficiaries can opt for monthly prescription co-pay installments. The initiative, part of the Inflation Reduction Act, aims to lower prescription costs. Noteworthy points include cost estimator tools, reimbursements to pharmacies, timely notifications, and a grace period for missed payments. Public feedback is invited until September 20th.
CMS has released preliminary guidance for a novel initiative aimed at Medicare Part D recipients, allowing them to evenly distribute their out-of-pocket prescription expenditures across a full year.
The recently issued draft guidance, published on August 21, outlines the protocol for Part D plans to oversee the newly introduced Medicare Prescription Payment Plan. It details how plans should identify potential beneficiaries for this program.
From 2025 onward, Medicare Part D beneficiaries will have the option to pay their prescription co-pays through monthly installments. This initiative forms part of a broader strategy to curtail prescription drug expenses for Medicare beneficiaries, established within the Inflation Reduction Act ratified in August 2022.
Key insights from the draft guidance include:
1. CMS will create tools to help beneficiaries gauge whether the program aligns with their needs. Although the program does not reduce drug costs overall, it prevents recipients from facing steep one-time payments.
2. Enrollees in monthly payment plans won’t owe any payment directly to their pharmacy upon prescription pickup. Part D plan sponsors are required to reimburse pharmacies following Medicare guidelines.
3. Part D plan sponsors are obligated to inform program participants about their anticipated monthly costs. Additionally, enrollees will receive information about the low-income subsidy program, designed to assist some beneficiaries in lowering their prescription expenses. The initiative encompasses all drugs covered under Part D.
4. Timely notifications for overdue payments must be provided by Part D plans. A two-month grace period is granted for missed monthly payments. Beneficiaries who fail to meet monthly costs risk removal from the payment plan, but not from their Part D coverage.
5. Medicare beneficiaries can elect to participate in monthly payments at any point during the year.
The CMS is welcoming public input on the draft guidance until September 20th.
