NASHP | National Academy for State Health Policy’s Post

CMS is releasing the final part two guidance regarding outreach and education for the Medicare Prescription Payment Plan which can help people with #Medicare prescription drug coverage manage prescription drugs costs. Starting in 2025, people with Medicare prescription drug coverage can choose the Medicare Prescription Payment Plan to spread the costs of their prescription drugs over the calendar year, instead of paying in full at the pharmacy each time they fill a prescription. Today’s guidance provides more information on how to make sure people with Medicare are aware of the program, especially those who are likely to benefit. Learn more: https://lnkd.in/e5D4i-ib

The removal of the AMP cap as part of ARP provisions, effective January 2024, has broader implications beyond impacting drug manufacturers. These changes could present administrative challenges for Medicaid enrollees, potentially leading to medication switches or delays in access, particularly when seeking approval for non-preferred drugs. The case of GSK's discontinuation of Flovent exemplifies how these provisions will affect Medicaid enrollees; specifically for young children. Curious to see how the effects of the ARP provisions targeted at the commercial sector will influence patient outcomes. This article published by KFF explains the significance of lifting the rebate cap. #NDRA #HighCostDrugs #AMP #ARP #HealthcarePolicy

#CaliforniaAccessCoalition's Executive Director, Dr. Le Ondra Clark Harvey, issued a statement in response to the Federal Trade Commission's Report on Prescription Drug Middlemen & Pharmacy Benefit Manager (PBM) Reform. In the report, Dr. Clark Harvey emphasizes the adverse impact that PBMs have on affordability and accessibility of prescription drugs. She also notes that six of the largest PBMs manage nearly 95% of all prescriptons in the U.S. and leverage their dominance to profit at the expense of patients and independent pharmacists. We are committed to addressing the barriers that delay patient access to life-saving prescriptions and advocating on their behalf. Read our full statement here: https://lnkd.in/gZwmAGkS

My latest article, in First Report Managed Care, outlines 5 potential unintended consequences of the Inflation Reduction Act that could impact drug prices and distribution. 1.      Medicare Part D plans may prefer drugs with high list prices and high rebates.  2.      The standalone prescription drug plan market will shrink as Part D enrollment increasingly shifts to Medicare Advantage.  3.      Pharmacies could face cash flow challenges.  4.      Transparency into the 340B Drug Discount Program will increase, presenting operational complications.  5.      Physician practice consolidation will accelerate. 

Medicare is undergoing a significant shift, bringing hope to millions of beneficiaries grappling with the high costs of prescription drugs. The Inflation Reduction Act of 2022 has led to big changes in the Medicare Part D program - including a new cap of $2,000 for prescription drugs. The Act focuses on reducing out-of-pocket patient expenses to curb Medicare's spending on prescription drugs. Let’s look at what the changes mean, who will benefit, and when the new rules come into effect. https://lnkd.in/e2_kVQZf

Take a look at the changes coming to you in 2025!!!! These changes, including a new $2,000 cap on out-of-pocket drug spending, will help to lower out-of-pocket costs for Part D enrollees but could also make it harder for some Part D plan sponsors to offer low-priced coverage, particularly sponsors of stand-alone prescription drug plans (PDPs).

Starting in 2025, the Medicare Prescription Payment Plan provides the option to people with Medicare prescription drug coverage to spread the costs of their prescription drugs over the calendar year rather than paying in full at the pharmacy counter each time they fill a prescription. People with Medicare must opt into the Medicare Prescription Payment Plan to utilize the new benefit. Notably, this payment option launches at the same time that all individuals with Medicare prescription drug coverage will begin to have their annual out-of-pocket prescription drug costs capped at $2,000, providing needed financial relief for high prescription drug costs.

The White House Projects $6 Billion Medicare Savings from IRA Drug Price Negotiations in 2026 The Biden Administration's Inflation Reduction Act is projected to save Medicare approximately $6 billion in 2026 through its Medicare Drug Price Negotiation Program. This initiative aims to lower prescription drug prices, benefiting millions of Medicare beneficiaries by reducing out-of-pocket costs by an estimated $1.5 billion. The Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure highlighted the program's impact on improving access to life-saving medications. However, a report from PhRMA suggests that 3.5 million beneficiaries may experience an increase in costs, raising concerns about the IRA's broader effects. Despite legal challenges from the pharmaceutical industry, Centers for Medicare & Medicaid Services remains committed to expanding the program to include more drugs in future years. For more details please click the link! https://lnkd.in/dtqP-y6t #marketaccess #reimbursement #pricing #hta #heor #healtheconomics #medicaldevices #pharmaceutical 

Should have realized sooner the healthcare implications of the Inflation Reduction Act. One of those is the Medicare Prescription Payment Plan, also known as M3P or MPPP. Thanks to Chuka Ndukauba for helping me level up my knowledge. One of the several key parts below from the CMS Fact Sheet The Medicare Prescription Payment Plan is a new program created under the Inflation Reduction Act that requires Part D plan sponsors to provide their enrollees with the option to pay out-of-pocket prescription drug costs in the form of monthly payments over the course of the plan year instead of all at once to the pharmacy. The program begins January 1, 2025. Program participants will pay $0 to the pharmacy for covered Part D drugs, and Part D plan sponsors will then bill program participants monthly for any cost sharing they incur while in the program. Pharmacies will be paid in full by the Part D sponsor in accordance with Part D prompt payment requirements. https://lnkd.in/ejNV6SM8

The Medicare Annual Enrollment Period (AEP) is approaching, making it the ideal time for those with Original Medicare, Medicare Advantage, or Part D prescription drug coverage to review their needs for 2025.   From October 15th – December 7th each year, the AEP is an opportunity for beneficiaries to make necessary changes to Medicare coverages.  This year, it’s especially important for those managing rising prescription drug costs to understand the upcoming 2025 changes to Part D. In our latest blog, we explore the end of the “Donut Hole” or coverage gap, out-of-pocket costs beneficiaries can expect, and other key considerations for AEP.  Read our latest blog post to learn more!