Medicare Prescription Payment Plan Info
In August 2022, President Biden signed the Inflation Reduction Act of 2022 (P.L. 117-169) into law. The prescription drug law makes improvements to Medicare by expanding benefits, lowering drug costs, and improving the sustainability of the Medicare program for generations to come. It provides meaningful financial relief for millions of people by improving access to affordable treatments and strengthening Medicare, both now and in the long run.
Updates
October 23, 2024
- Medicare Part D Open Enrollment: The 2025 Medicare Part D open enrollment period is now underway, starting on October 15th. This will be the first plan year with a full redesign of the Part D benefit, which is resulting in a notable shift in plan offerings, formularies, and premiums. It’s crucial for organizations serving Medicare Part D enrollees to understand how patients may have changed, as this can significantly affect plan choices. A recent Avalere analysis of the MA and Part D landscape files uses a volume-weighted average to assess premium changes. Soon, Avalere will be releasing a subsequent analysis of the CMS formulary files to evaluate coverage and tiering of prescription drugs with full implementation of Part D redesign. This analysis will include insights on how Medicare negotiation of 10 selected drugs may impact patients, as health plans prepare for 2026 and beyond.
- $2 Generic Drug List: On October 9th, CMS released an RFI for the Biden Administration’s Medicare $2 Drug List Model, including a preliminary list of 101 drugs. This RFI presents an opportunity to provide feedback through the RFI comment period. Please contact James Horner if your organization needs assistance in drafting or submitting RFI comments.
- Notice of Benefit and Payment Parameters (NBPP): On October 4th, CMS released the draft 2026 Notice of Benefits and Payment Parameters (NBPP). The NBPP is an annual rule that establishes requirements for commercial health plans and health insurance exchanges. Comments are due on November 12. You may access Avalere’s Take, for free, here. Subscribers of Avalere Policy 360 series receive on a regular basis Avalere’s Takes on policy developments.
- Medicare Drug Price Negotiation Program Final Guidance: On October 2nd, CMS released final guidance on the 2027 drug price rule, which includes significant changes related to patient engagement. We will continue to monitor these developments and their implications.
August 16, 2024
CMS announced that they have reached agreements with the manufacturers of the initial 10 drugs selected for Medicare negotiation as directed under the Inflation Reduction Act. CMS estimates that with the newly negotiated prices for these 10 drugs Medicare will save an estimated $6 billion. The Fact Sheet on the negotiated price can be found here.
July 16, 2024
CMS released the final part two guidance for the new Medicare Prescription Payment Plan after considering the public comments. This guidance primarily focuses on Part D enrollee education, outreach, and communications related to the Medicare Prescription Payment Plan.
This guidance builds on the final part 1 guidance, which focuses on operational requirements for the program, issued on February 29, 2024, and is accompanied by the release of the final Medicare Prescription Payment Plan model materials.
Click here to read the full Press Release.
Links to Resources
Fact Sheet: Medicare Prescription Payment Plan Final Part One Guidance
Medicare Prescription Payment Plan Implementation Timeline
Updated implementation timeline
Medicare Prescription Payment Plan: Final Part One Guidance
Medicare Prescription Payment Plan Part One Q&As
Medicare Prescription Payment Plan M3P Timeline
Updated implementation timeline
Avalere analysis of the MA and Part D landscape
RFI for the Biden Administration’s Medicare $2 Drug List Model