The Inflation Reduction act, passed by Congress in August 2022, introduced the Medicare Prescription Payment Plan (MPPP)—a program that allows Medicare Prescription beneficiaries to spread their out-of-pocket costs over the course of their plan year. This is great news for participants who will undoubtedly have greater access to their prescriptions, but it means a lot of work for the Medicare Prescription Drug Plans (PDPs), Medicare Advantage (MA) plans, and Employer Group Waiver Plans (EGWPs) that will now have to offer these payment plans. Enrollment will start October 15, 2024, so plans need to act now.
The truth is that Medicare plans are not set up to offer the financial services that the MPPP demands. Until now, they didn’t need the technology or workflows to support these types of financial transactions. Currently, beneficiaries pay their out-of-pocket costs up front and plans reimburse pharmacies for their portion.
Transactions like these are simple, straight forward, and fit nicely into the traditional claim adjudication process, but the MPPP complicates things significantly. Most systems do not have the sophistication to calculate payments based on Centers for Medicare & Medicaid Services (CMS) guidelines. MPPP demands more than spreading a fixed amount over a defined period of time. These systems also do not take into account the specific eligibility requirements beneficiaries need to meet before enrollment.
Not only will plans have to calculate and track monthly payments for beneficiaries, they’ll also have to separate MPPP transactions from standard health plan transactions. For example, plans will need to be able to produce one invoice for plan premiums and a second invoice for MPPP payments. There’s a lot to consider.
Operating a finance company will require completely new skills. Medicare plans will have to educate their beneficiaries, informing them of how the plan works and how their monthly payments are calculated. They’ll have to invest heavily in customer service to resolve conflicts with people who do not understand their charges, payments, and to work with members who have missed payments. They’ll need to hire people who specialize in banking and finance regulations to make sure their payment plans are compliant.
Current health plan systems and pharmacy benefit manager systems (PBMs) do not support the creation and administration of payment plans. That’s why we developed HLTHCard, and it does more than just handle financial transactions. HLTHCard was developed with the latest technology, specifically with MPPP in mind.
Our platform has functionality to educate and enroll beneficiaries. It can process transactions, calculate payments, and generate invoices—all while remaining compliant with healthcare, banking, and payment regulations. Medicare plans can use HLTHCard to provide customer support, answering beneficiary queries and handling reports on fraudulent transactions. HLTHCard gives Medicare plans everything they need to administer Medicare Prescription Payment Plans. Please contact us, and we’ll make sure you’re ready to start enrolling beneficiaries in October.
