The Inflation Reduction Act (IRA) introduced several changes to the Medicare landscape. One of the biggest changes that impacts members and plans alike is the Medicare Prescription Payment Plan (MPPP) program. Most Medicare plans that offer a prescription drug benefit are required to offer an MPPP program to assist enrollees in managing their out-of-pocket spend over the course of the plan year. As with any new program, there are many moving parts and processes to consider as we move from implementation to go live. The following is a chart of oversight elements to consider monitoring to ensure optimal compliance.
| AREA | CONCERN | ACTIONS |
|---|---|---|
| Pharmacy Education and Interactions with Participants | Lack of pharmacy knowledge about MPPP notification and claims processing requirements. |
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| Daily Claims Oversight | MPPP participants still paying a cost-share at point-of-sale due to pharmacy misunderstanding the MPPP claims adjudication process. |
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| Member Confusion | Member confusion about whether they are likely to benefit with the MPPP as well MPPP participant confusion about monthly invoice. |
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| Billing Concerns | MPPP invoices will not match cost-share amounts or EOBs causing confusion for members on whether they were billed correctly.
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| Urgent Election Processes | Member elects into the MPPP via the urgent election process and requires a refund.
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Feeling overwhelmed? BluePeak can help!
By prioritizing thorough oversight and monitoring activities for individuals that elect to participate in MPPP, sponsors can ensure they remain compliant and continue to deliver high-quality services that their beneficiaries expect. Contact [email protected] to learn more about how we can help build out your oversight and monitoring processes to assist in yielding a successful program.
