The Centers for Medicare & Medicaid Services (CMS) on Monday released the first of two draft guidance documents that outlines the requirements and procedures for certain aspects of the new Medicare Prescription Payment Plan.
The program is part of the Inflation Reduction Act, which gives people with Medicare prescription drug coverage (Medicare Part D) the option to pay out-of-pocket costs in monthly payments spread out over the year, starting in 2025.
The initial draft guidance focuses on helping Medicare Part D plan sponsors and pharmacies prepare for the new program and build the necessary infrastructure for successful implementation. It includes and seeks comment on identifying Medicare Part D enrollees likely to benefit from the program, the opt-in process for Part D enrollees, program participant protections, and the data collection needed to evaluate the program. Comments on the proposed guidance will be accepted through September 20 and will be considered during co development of the final guidance. CMS expects to issue final part one guidance in early 2024.
The second part of the guidance will be released for comment in early 2024 and will focus on Medicare Part D enrollee outreach and education, Medicare Part D plan bid information, and monitoring and compliance. CMS also intends to develop tools, such as calculators, to help people with Medicare Part D and their caregivers learn what monthly payments may look like under the new program.
“The new Medicare Prescription Payment Plan helps those who struggle the most with high upfront prescription drug costs and provides a way to ensure people with Medicare can get the life-saving medications they need,” said Meena Seshamani, M.D., Ph.D., CMS deputy administrator and director of the Center for Medicare, in the announcement. “Public feedback, both through comments on this draft guidance and extensive engagement, continues to be instrumental in the implementation of the prescription drug law and delivering on the promise of more affordable drugs for people with Medicare.”
For additional information, see the CMS fact sheet, implementation timeline, and the draft guidance document.