This is an AArete Pharmacy insight
With the release of the second round of guidance for the Centers for Medicare & Medicaid Services’ Medicare Prescription Payment Plan (MPPP), healthcare industry companies and vendors now have a much clearer understanding of how the changes will affect operations and operating margins.
As expected, there were no big surprises in the guidance, which provided more details on outreach, education, and communications requirements for Part D sponsors. The guidance served more as an update and reinforced the importance of health plans, pharmacy benefits managers (PBMs), and vendors working collaboratively to ensure accurate calculation of the maximum monthly payment cap and reconciliation, especially given the other Part D benefit design changes that start on Jan. 1, 2025. One thing has also become clear: Health plans will need to allow thorough testing by PBMs – and documentation of results and process changes – at the pharmacy level, so the protocol is approved by all parties well before regulations come into effect.
MPPP poses substantial operational and administrative challenges for plan sponsors. To succeed, plan leaders must ensure that all departments – claims processing, billing, coding, accounting, and marketing/communications – work in harmony to mitigate compliance risk and guard against cost overruns. That same level of system integration also will need to be in place with key partners (PBMs, pharmacies, and any relevant outside vendors) so member data is regularly updated to avoid disruptions as well as delays in billing, payment, and medication dispensing.
AArete Managing Director Leslie Lotano-Saba RPh, MS, who leads our Pharmacy Solutions practice, was invited to write a guest article for HealthExecWire on four strategies that health plans should implement so their organizations will be ready when MPPP goes into effect at the beginning of 2025.
Read Leslie’s full article here: https://healthexecwire.com/4strategies
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