Opportunities abound with the new Prescription Drug Payment Plan

“I will gladly pay you Tuesday for a hamburger today.”

-       J. Wellington Wimpy (E.C. Segar)

Medicare Advantage carriers are scrambling

If your business works with a Medicare Advantage carrier, the new Medicare Prescription Payment Plan could create new business opportunities for you. Digital assets, outreach campaigns and AI platforms will be critical tools to communicate and operationalize the new program.

If your organization provides care to seniors who take high-cost drugs, communicating this new prescription drug cost savings program will likely lead to improved medication compliance and happier patients.

Capping Prescription Drug Out-of-Pocket Costs

Beginning in January 2025, all Medicare Advantage plans covering prescription drugs will be required to offer consumers the option to pay their out-of-pocket costs for high cost drugs in monthly installments instead of all at once at the pharmacy.

Seniors who join their plan’s program will pay $0 at the pharmacy for their drugs, instead of the normal cost share. The Medicare Advantage plan will pay the pharmacy the total amount owed and then bill the senior in monthly installments throughout the balance of the calendar year.

Opportunity abounds in helping carriers communicate to seniors what the program is, how to enroll, how it works, and why they are getting a bill in September for a drug they took February.

Why is this matters to seniors

Our research has found that fully 25% of seniors in a Medicare Advantage plan “sometimes” or “often” skip their prescription drugs because they cannot afford them, creating serious health risks.

 Currently, a senior taking a drug like Eylea, Rituxan and Prolia faces out of pocket costs in the $660 - $4,600 range per prescription fill according to research by the Kaiser Family Foundation. The new program aims to alleviate some of the financial burden, though certainly not all, by spreading the payment out over the balance of the calendar year.

The challenges

The burden of explaining this new program to seniors falls to the Medicare Advantage carriers. They will be required to not only figure out a way to pre-pay the pharmacies, but also how to collect monthly payments from the seniors.

Imagine a 75-year-old grandmother who fills a prescription in February and starts getting monthly bills from her insurance company. She may well wonder if the bills are legitimate, or perhaps months later what the bill is for. When she does make a payment, will she write a check, pay with a credit card, or to go to the pharmacy to pay?

The possibilities for confusion is endless.

The opportunities

Groups that provide patient care to seniors – particularly in modalities that administer expensive drugs like oncology - should start to educate their staff about the program and develop materials explaining the program. Helping seniors understand how to better afford their drugs and take them as prescribed will likely result in improved outcomes. Better yet, engaging current patients to learn how they could best understand the program via user research would result in even more effective tactics.

Marketing and digital companies that support Medicare Advantage carriers via digital and print marketing, outreach and engagement, and supplemental benefits should start thinking strategically about the new opportunities this program creates. A little market intelligence paired with business strategy would go a long way to creating new revenue opportunities.

Now is the time to roll up your sleeves and offer to help carriers prepare. New business opportunities abound.

2itive is a Portland based consultancy founded by Erik Goodfriend, offering a unique combination of market intelligence, knowledge of healthcare payment systems and creative business strategy insights. Feel free to contact us at info@2itive.com