CMS pitches guidance for Medicare Part D monthly payment plan: 5 things to know

CMS published draft guidance for a new program that will allow Medicare Part D beneficiaries to spread out their out-of-pocket prescription costs over an entire year. 

In draft guidance published Aug. 21, the agency laid out how Part D plans should manage the new Medicare Prescription Payment Plan and how to identify patients likely to benefit from the program. 

Medicare Part D beneficiaries will be able to opt to pay their prescription co-pays in monthly installments beginning in 2025. The new program is one of several measures meant to cut the costs of prescription drugs for Medicare beneficiaries passed in the Inflation Reduction Act, signed in August 2022. 

Here are five things to note from the draft guidance: 

  1. CMS will develop monthly cost estimator tools to help beneficiaries determine if the program is a good fit for them. According to CMS' guidance, the program does not reduce the overall cost of drugs but prevents customers from facing high one-time payments. 

  2. Medicare beneficiaries who enroll in monthly payments will not owe any payment to their pharmacy when they pick up their prescriptions. Part D plan sponsors must reimburse pharmacies in accordance with Medicare guidelines. 

  3. Part D plan sponsors must inform people who choose to enroll in the program of their estimated monthly costs and provide enrollees with information about the low-income subsidy program, which may help some beneficiaries reduce their prescription costs. Part D plans cannot exclude any drugs covered under Part D from the program.

  4. Part D plans must provide beneficiaries with timely notices for late payments and provide a two-month grace period for missed monthly payments. If beneficiaries fail to pay monthly costs, they can be removed from the payment plan but not from their Part D coverage.  

  5. Medicare enrollees can opt-in to monthly payments at any time during the year. 

CMS is seeking public comment on the draft guidance until Sept. 20. 

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