BLOG: Smooth waters, rough sailing: The Medicare Prescription Payment Plan
Key takeaways:
- The Medicare Prescription Payment Plan can help patients spread out the cost of a prescription.
- Create a brief handout and phone script to explain deductibles and “smoothing.”
We’re still in the first quarter of the insurance plan year.
You’re still seeing patients every day who have rediscovered that they have a deductible because you refilled their prescription. Maybe they’re in your exam chair. Maybe they’re on the phone. Either way they are shocked — SHOCKED — that they have to pay the “full price” for whatever you prescribed. It’s Groundhog Day, and you have to explain it to them. Again.
Thankfully, we now have the Inflation Reduction Act (IRA) with a $2,000 per year cap on medication costs. It even did away with the abomination known as the “donut hole.” Just buy your medications (full price until you hit your deductible) until you hit $2,000, and then all of your prescriptions are free. Literally a 30-second sentence added to your standard deductible talk and you are out of the room or off the phone. No biggie.
If only.
Like so many dictums from D.C., the IRA brings a plethora of unforeseen consequences. For instance, that $2,000 cap can provide a disincentive to reduce the out-of-pocket costs of medications (see my upcoming post for a real-world dry eye disease example of why and how), and your patient can find themselves on the hook for a big number. Someone at Medicare realized this and created the Medicare Prescription Payment Plan (MPPP), commonly known as “smoothing,” to help patients spread out the cost of a prescription over the remaining months of the year. Sounds great, right?
Try explaining both deductibles and smoothing and finding time for lunch.
This post was supposed to give you a quick and easy way to manage this in your office. To explain to your patients how to maneuver in this new system so that they don’t end up on the hook for all $2,000 at once. Not gonna happen. There aren’t enough minutes in an hour to do this and provide care. You still have to participate in the prior authorization game and look at formularies to determine what has the best coverage. You don’t have the time. No one does.
I did the work. I went to Medicare.gov and read everything about the MPPP to write a brief instructional to share with my patients and you. Sadly, they’ve managed to make a difficult concept (cost/number of months remaining in the year until payments on all scripts = $2,000) so ridiculously complicated that Will Hunting would have just erased the blackboard, waxed the floor and headed home. Minnie Driver never gets discovered. Ben Affleck doesn’t even marry JLo. It would take less time to watch Good Will Hunting than it would take to explain “smoothing” to your average Medicare patient.
Don’t even try.
Do create a brief half-page handout and phone script to explain the deductible thing and to alert Part D patients that there is a program that can spread out the cost of their medications. Do inform them that they can see the details by going to Medicare.gov and searching for “smoothing.” Do tell them to turn their Medigap/Part D insurance card over, call the number on the back and ask to enroll in the MPPP. No questions. No discussion. Everyone has a limit. This one is mine. Explaining the IRA and MPPP is asking too much. Don’t do it.
You and your staff deserve lunch.
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