Under the CMS Medicare Prescription Payment Plan (M3P), beginning CY 2025, all Medicare Part D plans must offer enrollees the option to spread out their out-of-pocket (OOP) prescription drug costs over the plan year, rather than pay at the point of sale.
Among other goals, this initiative aims to:
- Relieve financial burdens: Under M3P, OOP drug costs will be paid through capped monthly payments–eliminating potentially large sums that would need to be paid upfront at the pharmacy counter. This structure also helps make costs more predictable.
- Improved medication access: Cost is one of the greatest barriers to adherence. However, opting into M3P results in a $0 copay at the point of sale, which could enable beneficiaries to fill their prescriptions more regularly.
However, this mandate includes a number of key requirements for plans–and that’s where Abarca comes in.
A seamless approach.
Abarca is providing a turnkey solution that enables plans to manage M3P and their regular pharmacy benefit functions.
This solution helps to tackle some of the program’s most intensive requirements, including:
- Beneficiary outreach and election to participate. We will help identify, educate, and onboard potential participants–without creating additional burdens for team members or enrollees.
- Claims management, pharmacy payments, and reporting. Along with claims monitoring and processing, our team will help track “true” member cost shares and provide in-depth reporting on other aspects of the program.
- Beneficiary invoicing and collections. Our solution enables more efficient bill calculations, invoices, reconciliations, payment adjustments, and CMS reporting.
We have also created an internal committee that offers additional support and resources for plans. Among other initiatives, they will provide ongoing assessment of regulatory guidance, implement efficient workflows, develop internal and external education, and facilitate ongoing strategy sessions.
In short: We’re forging a better way for clients and their members to not only participate in M3P, but also get the most out of the program.