President Biden’s Inflation Reduction Act included the Medicare Prescription Payment Plan (MPPP or M3P). MPPP allows beneficiaries to spread their out-of-pocket costs across their plan year, significantly increasing their access to their prescriptions. But what does this mean for the Medicare Prescription Drug Plans (PDPs), Medicare Advantage (MA) Plans, and Employer Group Waiver Plans (EGWPs) that will have to administer these new payment plans?
Many Medicare organizations believe they can implement MPPP with simple modifications to their billing systems, but this isn’t the case. The Centers for Medicare & Medicaid Services (CMS) guidelines for administering MPPP make it clear that plans must do more than simply spread a fixed amount over a defined period. CMS has expressed concern about maintaining transparency around out-of-pocket transactions and mitigating fraud.
Current billing systems aren’t ready to deal with the complexity of MPPP demands, so we developed HLTHCard, our end-to-end turnkey solution. Plans will have to start enrolling beneficiaries on October 15, 2024 and administering payment plans on January 1, 2025, so please get in touch with us to learn more.
Before the MPPP, plans processed one pharmacy claim to determine how much they would reimburse the pharmacy and calculate beneficiary cost sharing. The current platforms and integrations were designed to support these relatively simple transactions. The MPPP makes everything more complicated.
Coordination of Benefit (COB) claims complicate the process of payment plan calculations. Medicare plans must invest significantly in their current technology solutions to enable the tracking and incorporation of COB claims into the payment plan calculation. HLTHCard’s MPPP payment plan module seamlessly integrates with existing systems and third-party partners, like Pharmacy Benefit Managers (PBMs), meaning plans won’t have to make significant changes to their systems to calculate and administer payment plans.
Without HLTHCard, Medicare plans should also expect to invest heavily in their Customer Service departments. They will need to enhance existing systems and expand staff knowledge to educate and enroll beneficiaries. HLTHCard has multiple opt-in methods, including the HLTHCard portal, customer service representative, or mobile device. Our platform has resources explaining MPPP to potential beneficiaries, highlighting the program’s benefits, and providing essential prescription cost assistance details.
Plans will also need to grow their Customer Service team. Call volume is expected to increase significantly, as well as field calls and emails from beneficiaries about their bills, how their payments were calculated, and how they can make payments. They’ll need systems in place to report fraudulent transactions. Using the latest, cutting-edge technology, HLTHCard does all of this and more. Our Customer Service Representatives have expert knowledge of MPPP, and beneficiaries can reach them in various ways, including phone, email, and live chat.
With HLTHCard, Medicare plans can stop worrying about the mountain of work MPPP has placed before them.
