Medicare Prescription Payment Plan

[rmhaire]

Do they allow Watchtower pamphlets?

No idea. But I did notice that nothing was mentioned about bringing your checkbook.

 

[Duaine]

Will this work?

 

[Duaine]

The key change in the final part one guidance is the establishment of the threshold for identification of Part D enrollees who are likely to benefit. This thresh hold is a $600 pharmacy POS threshold based on a single prescription. This approach identifies Part D enrollees with a very high likelihood of benefiting from the Medicare Prescription Payment Plan program, while reducing the risk of identifying Part D enrollees for whom the program may not be as helpful.

What is the role of pharmacies in this new Medicare Prescription Payment Plan? The law requires Part D sponsors to notify the pharmacy when one of their Part D enrollees incurs out-of-pocket costs for covered Part D drugs that make it likely the individual may benefit from the program.

If a Part D enrollee has cost sharing for a single covered Part D drug of $600 or more and has not already opted into the program, the Part D sponsor will be required to notify the pharmacy to inform the individual about the program.

The pharmacy will provide the Part D enrollee with the Medicare Prescription Payment Plan Likely to Benefit Notice, a standardized notice that all Part D sponsors are required to use.

Can individuals opt out of the Medicare Prescription Payment Plan once they have opted in? Can an individual's participation be terminated?Yes, Part D plan sponsors must have a process in place to allow their program participants to opt out at any point during the plan year. Part D plan sponsors will continue to send monthly bills after someone opts out, and,though they cannot require it, they can also give the Part D enrollee the option to repay their outstanding balance as a lump sum. After opting out, the individual will pay any new out-of-pocket costs directly to the pharmacy

 

[straightnochaser]

The key change in the final part one guidance is the establishment of the threshold for identification of Part D enrollees who are likely to benefit. This thresh hold is a $600 pharmacy POS threshold based on a single prescription. This approach identifies Part D enrollees with a very high likelihood of benefiting from the Medicare Prescription Payment Plan program, while reducing the risk of identifying Part D enrollees for whom the program may not be as helpful.

What is the role of pharmacies in this new Medicare Prescription Payment Plan? The law requires Part D sponsors to notify the pharmacy when one of their Part D enrollees incurs out-of-pocket costs for covered Part D drugs that make it likely the individual may benefit from the program.

If a Part D enrollee has cost sharing for a single covered Part D drug of $600 or more and has not already opted into the program, the Part D sponsor will be required to notify the pharmacy to inform the individual about the program.

The pharmacy will provide the Part D enrollee with the Medicare Prescription Payment Plan Likely to Benefit Notice, a standardized notice that all Part D sponsors are required to use.

Can individuals opt out of the Medicare Prescription Payment Plan once they have opted in? Can an individual's participation be terminated?Yes, Part D plan sponsors must have a process in place to allow their program participants to opt out at any point during the plan year. Part D plan sponsors will continue to send monthly bills after someone opts out, and,though they cannot require it, they can also give the Part D enrollee the option to repay their outstanding balance as a lump sum. After opting out, the individual will pay any new out-of-pocket costs directly to the pharmacy

Thanks for getting the thread back on track, good info here for all the naysayers.

 

[somarco]

Move along folks . . . nothing to see here . . . just another dumpster fire

 

[sshafran]

For the first time, beginning in 2025, the prescription drug law, known as the Inflation Reduction Act, requires all Medicare prescription drug plans (Medicare Part D plans) — including both standalone Medicare prescription drug plans and Medicare Advantage plans with prescription drug coverage — to offer enrollees the option to pay out-of-pocket prescription drug costs in the form of capped monthly payments instead of all at once at the pharmacy.

Medicare Prescription Payment Plan | CMS

Medicare Prescription Payment PlanFor the first time, beginning in 2025, the prescription drug law, known as the Inflation Reduction Act, requires all Medicare prescription drug plans (Medicare Part D plans) — including both standalone Medicare prescription drug plans and Medicare Advantage...

www.cms.gov

Above information posted for agents who are not too busy selling and are willing to take a few minutes for education that could help them better serve their clients and prospects . . .

Interesting!

Reminds me of UHC paying the deductible on Part B on G plans.

 

[Ashmeade]

Anyone have any insight onto which PBM is best apt to deal with this?

 

[somarco]

This is a little dated but I doubt the numbers have noticeably shifted . . .

Here are the biggest PBMs by 2022 market share, according to Drug Channels:

CVS Health / Caremark: 33 percent

Cigna / Evernorth / Express Scripts: 24 percent

UnitedHealth / OptumRx: 22 percent

 

[somarco]

Imagine the calls from clients calling because xyz insurance company keeps calling them, harassing them etc etc, because they missed their Rx payment..

Apparently that only applies to PDP clients. Guys (and gals) that sell MAPD claim they get zero complaints from their policyholders.

 

[goillini52]

Can I say Chinese fire drill without getting heat from the DEI crowd?

Racist