On Monday, the Biden Administration released
draft guidance for the Maximum Monthly Cap on Cost-Sharing Payments Program, which was established by the
IRA. In the draft guidance, the Centers for Medicare & Medicaid Services (CMS) announced that the name of the program will now be the Medicare Prescription Payment Plan.
The
IRA requires Part D sponsors to provide Part D enrollees with the option to pay their out-of-pocket (OOP) prescription drug costs in equal monthly payments throughout the plan year, beginning in 2025. Instead of the participant paying at the point of sale, the Part D sponsor will bill participants monthly for any cost-sharing they incur. The program will not reduce the total OOP costs for participants; it simply spreads those costs throughout the plan year. Additionally, the program will not affect what counts toward a participant’s deductible or annual OOP cost threshold.
The program is available to anyone enrolled in a Part D plan, including those in the Extra Help program. Part D enrollees will be able to enroll in the program prior to the beginning of a plan year, or in any month during a plan year, by completing the Medicare Prescription Payment Plan election process with their Part D sponsor.
All covered Part D drugs are included in the program, and Part D sponsors may not exclude any covered Part D drugs.
This is the first of 2 parts of guidance providing details for the Medicare Prescription Payment Plan. The comment period for this draft part 1 guidance will end on September 20, 2023. Final guidance will be issued in
early 2024.
Also in early 2024, CMS will issue draft part 2 guidance that will contain information on Part D enrollee outreach and education, Medicare Part D plan bid information, and monitoring and compliance requirements.
The draft guidance was accompanied by a
fact sheet and a
press release.
