- CMS: Medicare and Medicaid Programs: CY 2026 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program
- Public Inspection: CMS: Medicare and Medicaid Programs: CY 2026 Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program
- CMS: Medicare Program; Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction (WISeR) Model
- Public Inspection: CMS: Medicare Program: Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction Model
- CMS: Secretarial Comments on the CBE's (Battelle Memorial Institute) 2024 Activities: Report to Congress and the Secretary of the Department of Health and Human Services
- HHS: Patient Protection and Affordable Care Act: Marketplace Integrity and Affordability
- Public Inspection: HHS: Patient Protection and Affordable Care Act: Marketplace Integrity and Affordability
- Increased Risk of Cyber Threats Against Healthcare and Public Health Sector
- HRSA Announces Action to Lower Out-of-Pocket Costs for Life-Saving Medications at Health Centers Nationwide
- Announcing the 2030 Census Disclosure Avoidance Research Program
- Eight Hospitals Selected for First Cohort of Rural Hospital Stabilization Program
- CMS: Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2026 Rates; Requirements for Quality Programs; and Other Policy Changes; Correction
- CMS: Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2026 Rates; Requirements for Quality Programs; and Other Policy Changes; Correction
- CMS: Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly; Correction
- CMS: Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly; Correction
Medicare Announces Cap on Out-of-Pocket Costs and Medicare Prescription Payment Plan
Beginning in 2025, all Medicare plans will include a yearly $2,000 cap on covered out-of-pocket prescription drug costs. The cap only applies to drugs that are covered by their Medicare plan, making it especially important for those with Medicare to review their plan to make sure their specific drugs are covered. If people with Medicare have prescription drugs that are not covered by the plan they choose, they will not be able to fully benefit from the cap.
Plan Finder provides an opportunity to input your prescriptions to be able to easily see if a plan covers them and their preferred pharmacy.
Likewise, starting in January 2025, the Medicare Prescription Payment Plan will take effect. The Medicare Prescription Payment Plan is a new payment option in the Inflation Reduction Act, also known as the prescription drug law, that works with the current drug coverage to help manage beneficiary’s out-of-pocket costs for drugs covered by their plan by spreading them across the calendar year (January–December), participation is voluntary.
How does the Medicare Prescription Payment Plan help my patient?
- For a certain set of people, it will help to manage their out-of-pocket covered drug costs. This plan is not right for everyone and does not save money for patients, but helps spread out existing costs.
- Costs are spread out across the calendar year (January – December) through monthly payments through a health plan versus in a lump sum at the pharmacy counter.
How does the Medicare Prescription Payment Plan work?
- There’s no cost to participate in the Medicare Prescription Payment Plan.
- If this payment option is selected, each month the plan premium will continue to be paid, if they have one. A bill will be received from the health or drug plan to pay, instead of paying the pharmacy
- If a person with Medicare determines this program is right for them, please have them contact their plan.
We encourage you to visit:
https://www.medicare.gov/prescription-payment-plan
https://www.medicare.gov/drug-coverage-part-d.