The Centers for Medicare & Medicaid Services (CMS) released new draft guidance Monday on how it plans to roll out a program that allows Medicare members to spread out monthly payments for prescription drug purchases.
The cost-sharing option must be offered beginning in 2025 and comes on the heels of President Joe Biden etching the Inflation Reduction Act (IRA) into law. Federal agencies believe the plan could help customers avoid large, upfront out-of-pocket drug costs.
“For people with Medicare Part D who face high costs early in the year, today’s announcement will ease the burden of out-of-pocket prescription drug costs,” said Department of Health and Human Services Secretary Xavier Becerra in a statement. “This is one more example of how the president’s prescription drug bill is reducing costs and increasing access to life-saving medicines for our Medicare beneficiaries.”
Sponsors and pharmacies are expected to use the draft guidance (PDF) to see which enrollees benefit from the program as well as to understand the opt-in process and data collection that is required. It also includes requirements for Part D sponsors to reimburse pharmacies and how they should handle monthly billing.
“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they need,” said CMS Deputy Administrator Meena Seshamani, M.D., Ph.D. “Public feedback, both through comments on this draft guidance and extensive engagement, continues to be instrumental in the implementation of the prescription drug law and delivering on the promise of more affordable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.”
CMS will accept comments on the Maximum Monthly Cap on Cost-Sharing Payments Program, now called the Medicare Prescription Payment Plan, until Sept. 20. Additional guidance will be released in early 2024, focusing on Medicare Part D enrollee outreach and education, plan bid information, monitoring and compliance. The agency said it also wants to develop calculators to help members and their caregivers learn what monthly payments could look like under the new program.
The IRA addressed many health priorities, including expanding eligibility for low-income Part D subsidies and limiting premium growth on Part D to no more than 6%.