Medicare Part D Changes Are Coming in 2025
By Ben Matherne , Sr. Director, Biologics by McKesson
Navigating the complexities of Medicare can often feel overwhelming, especially when it comes to understanding annual changes. In 2025, Medicare beneficiaries will witness significant updates to Part D. These changes aim to make prescription medications more affordable and accessible for millions of seniors and individuals with disabilities.
Biologics by McKesson specialty pharmacy is committed to informing you about these important changes coming for Medicare Part D, specifically the introduction of Medicare Prescription Payment Plan that may impact treatment and care.
What is Changing?
Starting in 2025, Medicare Part D will implement two noteworthy changes designed to make prescription medications more affordable and accessible for patients:
Out-of-Pocket Spending Cap:
One of the most significant changes is the introduction of an annual out-of-pocket spending cap for prescription drugs. This means that once you reach a certain threshold in medication costs, you will not have to pay additional out-of-pocket costs (i.e., copayment) for the rest of the year. Starting in 2025, patients enrolled in Medicare Part D plans will pay no more than $2,000 out-of-pocket for ALL prescription drugs. Once that $2,000 out-of-pocket threshold has been met, there will be no cost for Part D prescription drugs.
New Medicare Prescription Payment Plan (or M3P):
Additionally, plan beneficiaries will have the ability to “opt-in” to the Medicare prescription payment plan or M3P. M3P allows beneficiaries to spread their out-of-pocket costs over the course of the year in predictable monthly installments, providing better financial predictability and management. You may hear this referred to as prescription smoothing.
This will NOT lower out-of-pocket costs but will help spread them more evenly throughout the plan year.
Make the Necessary Changes
Biologics encourages all patients to select a Medicare Part D plan that meets their healthcare needs and/or decide if the Medicare Prescription Payment Plan is right for you.
Medicare Part D beneficiaries can elect to enroll in the Medicare Prescription Payment Plan during open enrollment from October 15 to December 7, 2024. Part D beneficiaries will also be able to opt-in throughout the plan year. Once enrolled for 2025 benefits, patients will pay $0 at the pharmacy for Part-D covered drugs. Instead, patients will pay their Part D plan directly in a series of monthly installments designed to “smooth” patient costs across the 2025 plan year.
Monthly bills will not be sent to patients until the Medicare Prescription Payment Plan participant incurs an out-of-pocket cost. Additionally, the plan will consolidate costs across ALL prescriptions received by a patient into just one monthly bill, incorporating any additional costs across the course of the year. Thus, the actual payment amount may vary month by month, however the total out-of-pocket cost to patients will remain capped at $2000 for the entire year, regardless of how many prescriptions are covered under the plan.
Patients should receive feedback from their pharmacy if the pharmacy feels the patient would benefit from enrolling in the new Medicare Prescription Payment Plan. Please work with your specialty pharmacy or clinical team to decide if the changes to the Medicare Prescription Payment Plan will have an impact on your care.
We're Here to Help
To learn more about the changes to Medicare Part D, you can visit www.Medicare.gov . Or, if you have questions or concerns about the upcoming changes, please do not hesitate to contact our team at 888.850.4306 or www.Biologics.McKesson.com/contact for additional resources and support.
We understand that changes to healthcare coverage can be complex and sometimes overwhelming. Our priority is to ensure you have the support you need to continue receiving the highest quality care.