Prescribers' News: Cap on Medicare Prescription Costs
Posted 30 days ago by Susan Conaty-Buck
Cap on Out-of-Pocket Costs and Medicare Prescription Payment Plan
Beginning in January 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 your 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.
o 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.
For more information: