Tuesday, April 16, 2024

New Medicare Prescription Payment Plan: A Key Step in Biden’s Fight Against High Prescription Costs for Seniors

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The Biden administration’s ongoing efforts to mitigate the high costs of prescription drugs for seniors and people with disabilities have taken a significant step forward with the release of the final guidance for the new Medicare Prescription Payment Plan, as part of the implementation of President Biden’s Inflation Reduction Act of 2022. This pivotal legislation, aimed at reducing the financial burden of prescription medications, is set to transform the way beneficiaries manage their drug costs under Medicare Part D.

The Centers for Medicare & Medicaid Services (CMS) announced the finalization of the initial guidance for this innovative payment plan, designed to facilitate a smooth transition for Medicare Prescription Payment Plan Part D sponsors. This move is essential for building the infrastructure needed to provide a seamless experience for enrollees choosing to participate. The Medicare Prescription Payment Plan, slated to begin in 2025, introduces an option for beneficiaries to spread their out-of-pocket costs over monthly payments throughout the year, rather than facing steep payments upfront at the pharmacy.

This initiative aligns with the broader goals of the Inflation Reduction Act to alleviate the financial strain of prescription drug costs. Notable achievements already include capping out-of-pocket expenses for insulin at $35 per month and ensuring vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) are available at no cost to individuals with Medicare prescription drug coverage.

New Guidance Eases Drug Costs, Ensuring Access to Medications for Seniors and the Disabled

Health and Human Services Secretary Xavier Becerra highlighted the critical nature of this law in preventing the difficult choices many seniors and people with disabilities face between affording medication and other essential needs. The plan to allow payments to be spread out over time is a testament to the administration’s commitment to lowering healthcare costs and ensuring access to life-saving medications for all Americans.

CMS Administrator Chiquita Brooks-LaSure emphasized the importance of today’s guidance in helping those with high upfront drug costs distribute their expenses more evenly throughout the year. This initiative is a key component of implementing the historic Inflation Reduction Act, aimed at reducing costs and improving access to necessary prescriptions for Medicare beneficiaries.

The final guidance, which incorporates feedback from public comments, outlines operational requirements for Medicare Prescription Payment Plan Part D sponsors in preparation for the new program. It details the process for identifying eligible enrollees, opting in, participant protections, and data collection for program evaluation. Additionally, it mandates that Part D sponsors must inform pharmacies to notify eligible individuals who meet a $600 out-of-pocket threshold for a single prescription at the point of sale.

Medicare Prescription Payment Plan

New Medicare Prescription Payment Plan and Cost Caps to Enhance Affordable Healthcare Access

The guidance requires that election requests by participants be processed within 24 hours during the plan year, ensuring timely access to the benefits of the program. This is complemented by the release of an Information Collection Request (ICR) for the Medicare Prescription Payment Plan, which includes model communication materials for Part D plan sponsors. Public feedback on these materials is invited through the ICR comment process, with a deadline for submissions set for April 29, 2024.

The Medicare Prescription Payment Plan is part of a suite of measures under the Inflation Reduction Act aimed at reducing healthcare costs. From January 1, 2024, beneficiaries with high drug costs will see an end to cost sharing in the catastrophic phase of Medicare Part D. In 2025, the out-of-pocket prescription drug costs will be capped at $2,000 for all Medicare Part D enrollees. The law also expands eligibility for the Low-Income Subsidy program, benefiting nearly 300,000 current enrollees and potentially aiding an additional 3 million people. Insulin costs are capped, and coverage for recommended vaccines without patient cost sharing is provided, marking significant steps toward more affordable healthcare for Medicare beneficiaries.

This comprehensive approach not only aims to make prescription drugs more affordable but also ensures that beneficiaries do not have to compromise on their health due to financial constraints. The final guidance and the accompanying measures underscore the administration’s dedication to addressing the challenges of high healthcare costs, promising a future where access to essential medications is within reach for everyone under Medicare.


Resource: CMS GOV, February 29, 2024

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