Major Changes Coming to Medicare Part D for Pharmacies and Their Patients in 2025

With Part D open enrollment underway, significant changes are on the horizon for 2025 that will benefit patients by reducing prescription drug costs and impacting IPC pharmacy members. Here’s what you need to know:

1. Elimination of the “Donut Hole”: Starting in 2025, Medicare Part D will introduce a $2,000 cap on patient out-of-pocket costs, effectively eliminating the coverage gap known as the “donut hole.”
2. New Optional Monthly Payment Plan: The Medicare Payment Plan Program (MPPP) will allow seniors to opt into a monthly payment plan for out-of-pocket costs (co-insurance and co-pays) exceeding $600. This program is available throughout the year once the $600 threshold is likely to be met.

These changes will require pharmacies to adjust how they communicate with patients and process claims. It’s crucial for pharmacies to inform patients about their rights under the new MPPP and ensure claims are handled correctly to avoid triggering Part D audits.

To help pharmacies prepare for these changes, IPC is providing resources that explain the new patient cost-share cap and the payment plan program. Please review this information carefully and stay updated with instructions from your PSAO on handling these claims properly.

NCPA Slides on Implementation of IRA Drug Pricing Provisions

NCPA Slides on Medicare Prescription Payment Program

PSW Medicare Prescription Payment Program

For any questions, contact IPC’s Government Relations Department at [email protected].