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

Even though Part D open enrollment has ended, there are 2 important changes 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. It’s important to remember that starting in 2025 all newly Part D eligible patients can choose the payment plan option at the time of their initial enrollment. Pay close attention to any Part D updates 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].