Beginning in 2025, the prescription drug law, known as the Inflation Reduction Act, requires all Medicare prescription drug plans (Medicare Part D plans) — including both standalone Medicare prescription drug plans and Medicare Advantage plans with prescription drug coverage — to offer enrollees the option to pay out-of-pocket prescription drug costs in the form of capped monthly payments instead of all at once at the pharmacy.
Build v Buy and Vendor Selection
One of the first considerations of M3P is determining whether a build or buy approach is more suitable for the Plan’s needs. There are a variety of vendors offering M3P services and the large PBMs are also offering solutions. Most solutions vary in the level of support provided from minimal to full service. BluePeak can assist in evaluating potential vendors, assessing their capabilities, conducting price comparisons, and ensuring alignment with your goals and requirements.
Members “likely to benefit”
Since M3P must be made available to any member that elects it, identifying a projected volume can be difficult to calculate. These volume projections have direct bearing on the solution, level of effort and costs. BluePeak can analyze your Plan’s members to identify members currently taking drugs that would likely benefit by participating in the M3P program.
Readiness and Implementation
BluePeak can support the implementation of M3P at every stage of the process. This includes:
- Enrollment
- Marketing
- Billing
- Claims Processing
- Planning for questions and complaints
- Termination
Communication and Training Strategy
Many stakeholders will be impacted by M3P. BluePeak can help you develop comprehensive training, education and communication strategies for members, brokers, agents, call center and plan representatives.
Oversight and Monitoring
If M3P is delegated to a vendor, Plans will need to have oversight over the process including routine monitoring and metrics.
We are your trusted partner.
We are a trusted partner to some of the most respected pharmacy and healthcare organizations, including: Medicare Advantage and Prescription Drug Plans, Medicaid Programs, Pharmacy Benefit Managers, Employers, Medicare related payers, such as SPAPs and ADAPs, as well as law firms, marketing firms and supporting entities.