Medicare Prescription Payment Plan Final Part Two Guidance on Select Topics, Implementation of Section 1860D-2 of the Social Security Act for 2025, and Response to Relevant Comments
On July 16th, the Centers for Medicare and Medicaid Services (CMS) released final part two guidance regarding the plan outreach and education for the Medicare Prescription Payment Plan. This guidance includes policy directing plan outreach and education to increase awareness of the Medicare Prescription Payment Plan. To access the payment options outlined in the latest guidance, individuals with Medicare must opt into the Medicare Prescription Payment Plan to utilize the new benefit. Starting in 2025, Medicare Prescription Payment Plans will provide the option to people with Medicare prescription drug coverage to spread the costs of their prescription drugs over the calendar year instead of paying a lump sum at the time of purchase. In addition, the policy to cap the annual out-of-pocket prescription drug costs at $2,000 for all individuals enrolled in the Medicare prescription drug program will also begin. Authorized in the Inflation Reduction Act, the new cap on out-of-pocket drug costs is expected to provide needed financial relief for high prescription drug costs. The cap will also significantly impact rural enrollees who have higher rates of certain health conditions that requires costly medications.
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