The new year will bring changes to Medicare benefits. Beginning Jan. 1, 2025, all Medicare Part D beneficiaries will have an annual $2,000 cap on out-of-pocket costs for covered prescription drugs, including deductibles, copays and coinsurance payments. This change will automatically apply to all beneficiaries with Part D plans.
The new year will also introduce the Medicare Prescription Payment Plan (MPPP), a new voluntary program that allows Medicare and Medicare Advantage beneficiaries to pay prescription costs as monthly payments over a calendar year, rather than paying one lump sum at the pharmacy counter.
Informing eligible patients about this program before they receive prescriptions can offer greater flexibility by enabling budgeting in advance for medication costs, alleviate financial pressures and help prevent delays in treatment.
Deciding to Enroll in the MPPP
The MPPP program is voluntary, and interested beneficiaries must opt into the program through their Part D or Medicare Advantage plan. Patients may enroll at no cost at any point in the plan year by calling their plan directly or electing the MPPP option on the plan’s website.
The MPPP will be most beneficial for patients with high-cost prescriptions for chronic or complex disease, especially those expected to have high out-of-pocket costs early in the year. Deciding whether to enroll in the MPPP depends on individual variables, such as:
- Timing of prescriptions within the calendar year;
- Anticipated total out-of-pocket costs for all prescriptions; and
- How often prescriptions will need to be filled.
ACR partners at the Arthritis Foundation, Lupus Foundation of America and National Health Council provide additional resources to help patients determine if the MPPP will be right for them.
How the MPPP Works
Patients enrolled in the MPPP will pay $0 at the pharmacy for their prescriptions. Any out-of pocket costs for covered Part D drugs will be divided into monthly payments, which may be adjusted depending on the patient’s cost-sharing and how many months remain in the calendar year. Beneficiaries will receive a monthly bill from their plan for drug costs, in addition to their monthly plan premium (if applicable).
Regardless of individual participation in the MPPP, all out-of-pocket Part D prescription drug payments will not exceed $2,000 for Medicare beneficiaries in 2025.
Upcoming changes to Medicare benefits mark a shift toward more predictable and manageable prescription drug costs for beneficiaries. As rheumatology professionals, understanding these changes will allow you to help eligible patients alleviate financial pressures related to drug costs.
