3 things to remember

[kgmom219]

In addition to everything else!

1. Biosimilar drugs can be changed at the pharmacy level. No doc approval required
2. Patient Assistance Programs are requiring enrollment into MPPP
3. Everyone is getting info on MPPP. If you don’t want to deal with a flood of calls/emails in December, better figure out how you telling them now.

 

[Fisher]

2. Patient Assistance Programs are requiring enrollment into MPPP

I have a question about the sources of your first two statements, but I'll stick with this question for now: Why would a drug manufacturer require this? The beneficiary is incurring no OOP cost, and the Rx is not processed through the PDP. How would MPPP benefit the manufacturer?

 

[somarco]

Patient Assistance Programs are requiring enrollment into MPPP

ALL plans? I saw something about Pfizer requiring folks to participate in "smoothing" . . . didn't know ALL plans require it.

Is this a PAP requirement or carrier?

 

[kgmom219]

ALL plans? I saw something about Pfizer requiring folks to participate in "smoothing" . . . didn't know ALL plans require it.

Is this a PAP requirement or carrier?

Novo Norodisk told me "yes, but we haven't informed patients". I called Prescription Hope, they didn't have a clue. Walgreens Alliance told me they are anticipating all PAP's to require it. Its not carrier specific, its the manufacturer.

KG Answer: We are anticipating that your PAP plan will require enrollment and recommend taking care of that between December 8th and 20th-before everyone goes on vacation at the carrier. And don't forget, get all your prescriptions filled prior to January 1. We don't like any of our clients in the pharmacy before January 15 unless absolutely necessary. Everyone there is either sick, meeting their deductible or their insurance is broken.

 

[kgmom219]

I have a question about the sources of your first two statements, but I'll stick with this question for now: Why would a drug manufacturer require this? The beneficiary is incurring no OOP cost, and the Rx is not processed through the PDP. How would MPPP benefit the manufacturer?

1. Medicare 2025 Final Rule. [EXTERNAL LINK] - Contract Year 2025 Medicare Advantage and Part D Final Rule (CMS-4205-F) | CMS
2. See Below.
3. I gave up on logic long ago. Its the GOVERNMENT and HEALTH INSURANCE-there is no logic.

 

[InsuranceGuy29]

1. Medicare 2025 Final Rule. [EXTERNAL LINK] - Contract Year 2025 Medicare Advantage and Part D Final Rule (CMS-4205-F) | CMS
2. See Below.
3. I gave up on logic long ago. Its the GOVERNMENT and HEALTH INSURANCE-there is no logic.

The government genuinely needs to get the hell out of this field. I realize it's a Federal program. I get it, but these people are absolutely clueless. That's why insurance companies and agents/brokers are involved. We do this everyday for a living. Maybe at least consult with us before you go making drastic policy changes?? Nah, too much common sense.

 

[Ron Van D]

So, no more MAPD's?