CMS Rules 2025

By Ed Crowe | General Articles | 0 comment | 4 October, 2023 | 0

CMS Rules 2025

CMS announced changes to drug cost rules. The Center for Medicare and Medicaid Services (CMS) adjusts rules and regulations yearly. This is to optimize the effectiveness of the federal Medicare program. Recently, they announced a new development that was a direct effect of President Joe Biden’s Inflation Reduction Act. The Inflation Reduction Act (IRA) included a larger redesign of the Medicare Part D prescription drug benefit. It is part of an attempt by the Biden administration. And, is intended to address the high cost of prescription drugs in the United States. Let’s discuss the CMS rules 2025.

Guidance

The Center for Medicare and Medicaid Services released the first of several guidance documents regarding this change, called the Medicare Prescription Payment Plan program. It is a voluntary program meant to allow Medicare beneficiaries to spread the out-of-pocket cost of their prescription drugs over twelve months. The Medicare Prescription Payment Plan, a monthly payment plan, is designed to help “those who struggle the most with high upfront prescription drug costs,” according to the director of Medicare, Meena Seshamani. The Inflation Reduction Act also included a $2,000 cap on out-of-pocket prescription drug costs under Part D, which will take effect in 2025.

Essentially, starting in 2025, seniors will be able to pay their prescription drug costs in capped, regular monthly payments instead of in lump sums at the pharmacy during pick up. According to a statement released concerning the new regulations by CMS, “This will be helpful for people with Medicare Part D who have high cost-sharing earlier in the plan year by spreading out those expenses over the course of the year.”

This is all good information and good news for beneficiaries, but insurance carriers have questions. There is not yet guidance on how this new regulation will affect the insurance carrier’s plans for 2025. CMS rules 2025 information will be available in the next draft of guidance that is released. And, carriers will have to wait until early next year.