🚨 Patient Assistance Programs – Part D Enrollees May No Longer Qualify Due to IRA/M3P 🚨

🚨 New M3P Fear Unlocked 🚨

Medicare Prescription Payment Plan
M3P / MPPP
Copay “Smoothing”
“Smoothing” Provision

Pfizer Patitent Assistance Program (PAP) recipients, enrolled in Part D, have begun receiving notices that alert them that opting in to the Medicare Prescription Payment Plan (M3P) will be a requirement for PAP Eligibility in 2025.

The Part D Enrollee will then have to attest to being unable to afford their monthly maximum cap payment in the M3P to determine if they meet the PAP qualifying criteria.

This means potential higher out of pocket costs for Medicare Part D beneficiaries with financial need. In fact, they could be responsible for their $2000 TrOOP now, due to this change.

😱 Many carriers didn’t know this was coming.

We have also heard that state assistance programs representatives (SHIP/SHIBA/SHINE) will be required to educated on the M3P, as it will be a requirement for state-based patient assistance programs. (This may vary by state)

We have received more than the notice attached. This one is from Oncology. Others are from the standard Pfizer PAP and contain a different address.

I called Novo Nordisk and Eli Lily this morning to inquire if they would also be implementing this change. At this time they have said no, but I anticipate this could change, as other manufacturers see this and likely follow suit.

😡 More expense for Part D Enrollees
💸 More expense for carriers
💰 More savings for manufactures

🏔️ Can you hear the rumbling yet?

💨 The M3P Avalanche is on the way.

Was the M3P created to punish carriers and benefit manufacturers and it just happens to help some Part D beneficiaries? Because it seems like it also has the potential to harm beneficiaries currently receiving a PAP, among others.

You can watch our recorded webinar on the M3P and the IRA here:

https://lnkd.in/erMBKTuu

Reach out to me if you have questions about it. Or would like a copy of the presentation.

I am also happy to help with agent education or speaking on the topic.

Thank you to our incredible agent Kailie Roosma whose amazing relationship with her client brought this to our attention right away!

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