Unpacking Medicare Prescription Payment Plan (MPPP)

High prescription drug costs burden Americans, especially seniors and those with disabilities on Medicare. The Inflation Reduction Act addresses this by allowing Medicare to negotiate drug prices, capping out-of-pocket expenses at $2,000 for Part D beneficiaries, and introducing the Medicare Prescription Payment Plan (MPPP) for monthly billing options, easing financial strain and improving budget management.

To ensure seamless compliance with MPPP requirements, health plans must adhere to essential timelines throughout the preparation and implementation phases. We are pleased to present this Everest Group report that demystifies MPPP for payers and pharmacy benefit management (PBM) players.

This report outlines the key timelines, objectives, and cost-sharing methodologies of MPPP, along with roles for payers and PBMs, implementation components, future use cases, and performance governance through operational KPIs. It provides a comprehensive guide for health plans to navigate and optimize MPPP participation.

Sneak Peek into the Report:

• Important timelines for MPPP, including milestones and deadlines vital for health plans
• MPPP’s key objectives, such as eligibility criteria, enrollment periods, benefits, billing, and cost-sharing details
• Cost-sharing methodology, including payment formulas for the first and subsequent months
• Roles and considerations for payers and PBMs across members’ MPPP election journeys
• Key solution components for implementing an end-to-end MPPP solution
• Forward-looking use cases that go beyond compliance
• Performance governance through key MPPP-specific operational KPIs