CMS implements prescription payment plan

Oct. 2024Important Notices

Your Medicare patients with high drug costs may benefit from participating in the Medicare Prescription Payment Plan, which will be available beginning on Jan. 1, 2025.

As part of the Inflation Reduction Act (IRA), all Medicare drug plans and Medicare health plans with drug coverage (such as Medicare Advantage plans) will be required to offer the Medicare Prescription Payment Plan. This new program will allow plan members to make monthly payments toward their out-of-pocket prescription drug costs over the course of the plan year instead of paying all at once at a pharmacy. (For more information on the IRA, please visit the CMS webpage about the Inflation Reduction Act and Medicare.

The Medicare Prescription Payment Plan will be available starting on Jan. 1, 2025. Program participants will pay $0 at their pharmacy for covered Part D medications, and Part D plan sponsors will bill participants each month for any cost sharing they incur while in the program. Pharmacies will be paid in full by the Part D plan sponsor in accordance with Part D prompt payment requirements. For more information about the program, please visit the Medicare Prescription Payment Plan page.

Medicare plan members who are likely to benefit from this program will receive information about how to enroll this fall.

If you have any questions about this matter, please contact your physician account executive or call Provider Services at 1-866-918-1595. As always, thank you for the excellent care you provide to our members.


Recent Announcements

The importance of PRD forms for complex patients and staying updated on changes

Personal representative designation (PRD) forms are critical to the care process for patients and providers alike. Not only do PRDs support accurate, efficient, and compliant patient care—they also streamline administrative processes.
Aug. 2025Important Notices

Important announcement: UPMC Health Plan retires MP.PA.147

This communication is in regards to UPMC Health Plan Policy MP.PA.147 – Diagnostic and Surveillance Colonoscopy, 18 Years Old and Older. UPMC Health Plan previously communicated that the prior authorization requirement under this policy would be paused until Sept. 1, 2025. However, policy MP.PA.147 has been retired, and this policy will no longer be implemented or active.
Aug. 2025Important Notices

CMS expands Medicare Advantage RADV audits to all eligible plans

On May 21, 2025, the Centers for Medicare & Medicaid Services (CMS) announced a substantial expansion of its Risk Adjustment Data Validation (RADV) audit program for Medicare Advantage plans.
Aug. 2025What's New