The Inflation Reduction Act’s (IRA) Medicare Prescription Payment Plan (MPPP) will launch in January 2025, introducing a new way for Medicare Part D plan enrollees to manage their out-of-pocket (OOP) drug costs. This program, previously known as “OOP smoothing”, will allow enrollees to spread their Part D OOP costs over monthly payments throughout the plan year, rather than paying the full amount upfront at the pharmacy.

In July 2024, the Centers for Medicare and Medicaid Services finalized the second of two guidance documents implementing the program for the 2025 plan year. The guidance details program parameters and requirements for Part D plans and pharmacies, such as required plan outreach to beneficiaries and notices that must be provided to Part D enrollees at the pharmacy counter.

Beyond plans and pharmacies, it will be critical for beneficiaries, caregivers, and providers to understand which Part D enrollees are most likely to benefit from the MPPP and what it means for treatment options. Finally, manufacturers will also want to consider the impact of the MPPP and what it means for Part D enrollee educational efforts and any charitable programs they provide.

Navigating the Changing Part D Landscape

This Insight is the first in a series in which Avalere will explore how the MPPP will reshape the landscape for Part D stakeholders, including patients and patient groups, manufacturers, Part D plans, and pharmacies and other providers.

For support in navigating the changing Medicare Part D landscape, connect with us.