Implementation of the Medicare Prescription Payment Plan (MPPP) on January 1, 2025, along with the new $2,000 out-of-pocket (OOP) cap, will significantly shift the Medicare Part D landscape. These changes will influence drug utilization patterns and require manufacturers to systematically reassess their , educational efforts, and other internal preparations. Building awareness of these changes and proactively adjusting strategies will be imperative for supporting patient access and helping beneficiaries navigate new benefits ahead of and into the 2025 plan year.

Increased Affordability and Drug Utilization

The MPPP’s primary aim is to enhance affordability by spreading OOP costs over monthly payments, particularly for Part D enrollees who experience high costs early in the year or over a short period of time. Increased Part D drug affordability from this program, coupled with the new $2,000 annual OOP cap, may have significant impacts on drug utilization. Beneficiaries who previously might have delayed or foregone treatment due to upfront costs may now be more likely to fill and adhere to their prescriptions. However, the utilization impact is likely to vary depending on the type of patient, their plan design, and the medications they take. Manufacturers should also prepare for potential shifts in utilization between Part B and D products given these Part D affordability improvements.

Considerations for Patient Assistance Programs

As part of MPPP implementation, manufacturers should also reevaluate their patient assistance programs. In particular, manufacturers may consider updating eligibility requirements and intake processes. PAP and hotline representatives will also need to be prepared to talk to beneficiaries about the MPPP and address questions. This engagement may include helping Part D enrollees learn more about the program, what it could mean for them, directing them to other appropriate resources to enroll or learn more about the program, and explaining how the MPPP will work with other changes to the Part D benefit in 2025.

Internal Education

Internal teams, such as marketing and field-facing teams, will need to be educated on the MPPP and the broader 2025 Part D benefit design changes to determine the impact on business operations and strategy, and to prepare for interactions with customers and other stakeholders. This education may include trainings for PAPs and other patient-facing teams to answer questions on the MPPP. Additionally, other teams should be prepared to engage with healthcare providers, pharmacies, and patient groups to build awareness of the program.

Education for Patients and Other Stakeholders

Manufacturers can also play a role in educating patients and other stakeholders about the MPPP. Manufacturers often already provide their own resources to educate beneficiaries about Medicare and the Part D program, so existing resources could be updated to reflect the MPPP. These resources can help provide additional tailored education and support to patients beyond the materials that may already be provided by the Centers for Medicare & Medicaid Services or other entities.

Manufacturers can also develop other educational resources to build awareness among providers and pharmacies so they are better equipped to communicate with Part D enrollees about the MPPP. By investing in these educational efforts, manufacturers can ensure that stakeholders that are closest to patient care can effectively communicate about the program.

Dive Deeper

As the Part D Annual Election Period for the 2025 plan year approaches, manufacturers must take strategic steps to prepare both internal teams and external stakeholders to navigate the MPPP and new Part D landscape. For support in navigating the changing Medicare Part D landscape, connect with us.

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