Frequently Asked Questions: Medicare Prescription Payment Plan (M3P)

In part 3 of our series on Medicare Part D changes, Accessia Health welcomed expert conversation and insight into what is happening with the Medicare Prescription Payment Plan (M3P) and how to navigate enrollment obstacles, improve awareness, and promote education. Following the discussion, we’ve put together a comprehensive list of the most frequently asked questions along with clear, helpful answers.

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What is the Medicare Prescription Payment Plan, or M3P?

The Medicare Prescription Payment Plan (M3P) is a new payment option in the prescription drug law that works with your current drug coverage to help you manage your out-of-pocket Medicare Part D drug costs by spreading them across the calendar year (January-December). Starting in 2025, anyone with a Medicare drug plan or Medicare health plan with drug coverage (like a Medicare Advantage Plan with drug coverage) can use this payment option. The Medicare prescription payment plan only applies to medication costs. Enrollees are still required to pay their monthly premiums. 

How does M3P work?

Once you opt into the payment plan, all drugs covered by your Medicare prescription drug plan are included.  When you fill a medication, your copayment or coinsurance for that fill, including any deductible, is spread out over the remaining months of the year. Enrollees pay nothing to the pharmacy and will receive a monthly bill from their prescription plan.  

Who would benefit from this new plan?

M3P may benefit people who cannot afford the full cost of their copay at once.  However, the payment plan does not lower your drug costs but rather allows you to manage them with a monthly payment throughout the year.

Are there any scenarios in which enrollment in M3P may not benefit the patient or could result in higher out-of-pocket costs?

Many factors determine if the Medicare Prescription payment plan option is best for you.  However, Medicare prescription coverage enrollees will pay no more than $2,000 for covered medications in a plan year, whether they opt in or not.

Are there any income restrictions for M3P?

No, there are income requirements to participate in the Medicare Prescription Payment Plan.

How do I enroll in M3P?

You can opt into the payment plan by contacting your Medicare prescription drug plan.

How do participants know what their copay is for a prescription?

Your copay depends on the cost of your covered medication fill and when you opt in. Once you opt into the Medicare Prescription Payment Plan, you pay $0 to the pharmacy and receive a bill each month from your plan. This amount will increase with each fill, but you will pay no more than the $2,000 cap for covered medications. To learn about your specific payment plan amount once you have opted in, you should contact your plan directly.

Is there a resource to calculate estimated out-of-pocket Part D prescription costs?

Yes! Advocates, patients, and providers can use Paytient’s Estimated Costs Calculator.

Can your M3P payment increase throughout the year? 

Yes, the amount of your payment is based on the medications you have filled.  Each time a medication is filled, the amount is added to the payment plan until the cost reaches the cap. If you are no longer taking a medication, you are still responsible for any fills previously included in the payment plan.

Is the $590 Part D initial deductible eligible for the M3P payment program?

Yes, if the $590 deductible must be met to fill the Part D-covered medication, the deductible amount billed would be included in the plan.

If a patient signs up for the M3P payment program and then chooses to cancel, are they billed a lump sum of their remaining balance, or do they continue to get monthly bills for the amount they were paying while enrolled?

You have the choice to pay off the balance or continue to pay the monthly amounts. After opting out, you will pay any new out-of-pocket costs directly to the pharmacy until they meet the cap. 

If a patient is enrolled in M3P, can they choose not to use M3P billing as the secondary payer for a less expensive drug, and instead use only their regular Part D (primary) coverage and pay the standard copay?

Once you opt into the payment plan, all out-of-pocket Medicare prescription drug costs will be billed monthly.  Therefore, if it is billed through your Medicare prescription coverage, it will be included.

If my medication isn’t included under the $2,000 out-of-pocket maximum, are there payment plan options available to help cover the cost?

Only medications covered by your Medicare prescription plan are included. However, if the drug is not covered by the plan, the enrollee would be responsible for the full cost of the fill. In this case, the enrollee could discuss a formulary exception or other options with their provider.

How can beneficiaries work with providers and advocates to enroll or learn more about M3P?

Enrollees should ask their provider or advocate for more information. However, with the assistance of a care provider or advocate, enrollees can gather the needed information to determine if this option is best for them.

Are there additional resources or support options available for individuals who may have difficulty affording their M3P payments?

If the monthly payment plan is still unaffordable and the enrollee is not eligible for low-income savings programs available, they can research patient assistance programs like those offered by Accessia Health and discuss with their provider.