The Medicare Prescription Payment Plan (MPPP) is here! As a new addition to Medicare, pharmacists all over the country are wondering how it will impact their practice and their patients. And, as a recent article from NCPA would indicate, pharmacies who have already started submitting claims for MPPP patients may not be following all the necessary steps.
The team at EnlivenHealth decided to put together an FAQ to address the most common concerns and provide guidance on how to move forward with this latest addition to the Medicare landscape.
What is the Medicare Prescription Payment Plan (MPPP)?
The MPPP is a new payment plan option introduced under the Inflation Reduction Act. Starting in 2025, it allows Medicare beneficiaries with prescription drug plans — including Medicare Advantage enrollees with prescription drug coverage — to spread their out-of-pocket prescription drug costs over the calendar year instead of paying the full amount at the pharmacy.
How does the Medicare Prescription Payment Plan work?
When a patient fills a prescription covered by their Medicare drug plan, they won’t pay at the pharmacy. Instead, they’ll receive a monthly bill from their health or drug plan. This bill will include the cost of their prescriptions, divided by the number of months left in the year.
How does the Medicare Prescription Payment Plan benefit patients?
The primary benefit of the MPPP is the ability to manage monthly expenses better by spreading out high drug costs over the year. This can be particularly helpful for patient with high-cost medications early in the year. It’s important to note that, while the program helps patients better manage their monthly prescription drug expenses, it does not save patients money or lower their drug costs.
What are some of the most common concerns pharmacists have about the Medicare Prescription Payment Plan?
Administrative Burden
Some pharmacists worry about the additional administrative tasks associated with the Medicare Prescription Payment Plan, such as providing notices to their Medicare patients, consulting patients on how the program works, and handling billing inquiries.
Patient Confusion
Any change in the payment process runs the risk of causing confusion among patients. And with patient confusion comes extra explanations and guidance from the pharmacy staff.
Impact on Cash Flow
Since patients will no longer be paying at the point of sale for their prescriptions, some pharmacists might be concerned about the delay in receiving payment. While waiting for reimbursements is nothing new in pharmacy, this will be putting even more money on a delayed payment schedule. Keep in mind, however, that pharmacies could benefit from avoiding credit card fees on claims while streamlining operations by eliminating the need to collect payments in the store.
How can pharmacists address the most common concerns about the MPPP?
Educate Patients
Take the time to explain the Medicare Prescription Payment Plan to your Medicare patients. Provide them with CMS-developed resources and answer any questions they may have.
Streamline Processes
Implement efficient systems for handling the new administrative tasks. This might include training staff and using software solutions to manage billing and notifications.
Stay Informed
Keep up to date with CMS guidance and update on the Medicare Prescription Payment Plan to ensure compliance and smooth operations.
How can pharmacists best utilize the MPPP with their patients?
Identify Eligible Patients
Use your pharmacy management system to identify patients who might benefit from the MPPP, especially those with high-cost medications. The payment plan could also help patients who are hesitant to enroll in medication synchronization because they don’t want to pay all their copays at once.
Provide Clear Communication
Ensure patients understand their new billing process and how it will help them manage their expenses.
Offer Support
Be available, both at the counter and over the phone, to assist patients with any issues or questions they have about their monthly bills and the Prescription Payment Plan.
What Medicare Prescription Payment Plan resources are available for pharmacists?
CMS provides various resources, including detailed guidance documents, FAQs, and other educational materials to help pharmacists navigate the MPPP. Make sure to check CMS.gov and Medicare.gov regularly for updates and new information. For example, Medicare’s website features a guide with information about signing up for the program, what to do after joining, and how to find programs that can help lower Medicare costs.
By understanding and effectively utilizing the Medicare Prescription Payment Plan, pharmacists can play a crucial role in helping patients manage their prescription costs and improve their overall healthcare experience.