CMS implements prescription payment plan

Your Medicare patients with high drug costs may benefit from participating in the Medicare Prescription Payment Plan, which will be available beginning on Jan. 1, 2025.

As part of the Inflation Reduction Act (IRA), all Medicare drug plans and Medicare health plans with drug coverage (such as Medicare Advantage plans) will be required to offer the Medicare Prescription Payment Plan. This new program will allow plan members to make monthly payments toward their out-of-pocket prescription drug costs over the course of the plan year instead of paying all at once at a pharmacy. (For more information on the IRA, please visit the CMS webpage about the Inflation Reduction Act and Medicare.

The Medicare Prescription Payment Plan will be available starting on Jan. 1, 2025. Program participants will pay $0 at their pharmacy for covered Part D medications, and Part D plan sponsors will bill participants each month for any cost sharing they incur while in the program. Pharmacies will be paid in full by the Part D plan sponsor in accordance with Part D prompt payment requirements. For more information about the program, please visit the Medicare Prescription Payment Plan page.

Medicare plan members who are likely to benefit from this program will receive information about how to enroll this fall.

If you have any questions about this matter, please contact your physician account executive or call Provider Services at 1-866-918-1595. As always, thank you for the excellent care you provide to our members.