CMS Publishes Part II of Guidance for Medicare Prescription Payment Plan

On Tuesday, the Biden administration released guidance on rules for the Medicare Prescription Payment Plan, a key aspect of the healthcare initiatives laid out in the Inflation Reduction Act of 2022 that aims to lower out-of-pocket costs for seniors with Medicare Part D prescription drug coverage.

The program is slated to launch in 2025, and will give those with Medicare drug coverage the option to spread out the costs of their drugs throughout the calendar year instead of paying in full each time they fill a prescription, AJMC explains.

The American Hospital Association (AHA) notes that the guidance is complimentary to guidance published in February and the upcoming national education and implementation effort  will be coordinated between plans, pharmacies, providers, manufacturers and advocacy groups.

In a press release, the Centers for Medicare and Medicaid Services (CMS) says that the program will be opt-in for beneficiaries and will be launched in tandem with the out-of-pocket prescription drug payment cap of $2,000 per year. From CMS Administrator Chiquita Brooks-LaSure:

This new payment option providers people with high Rx spending the option to spread out the costs of their prescription drugs over the calendar year and eliminate the burden of paying the total out-of-pocket cost upfront. CMS is continuing to implement the many important provisions of the Inflation Reduction Act to help people with Medicare access the prescriptions they need.