Medicare AdvantageAdministrativeLow impact
CMS implements prescription payment plan
UPMC Health Plan·Reimbursement
Effective date
Jan 1, 2025
We identified it
Aug 7, 2026
Summary
CMS is implementing the Medicare Prescription Payment Plan effective January 1, 2025, requiring all Medicare drug plans and Medicare Advantage plans to offer monthly payment options for prescription costs instead of lump-sum payments at the pharmacy. Billing teams should be aware that Part D plan sponsors will bill patients monthly for cost-sharing, while pharmacies receive full payment from plans according to prompt payment requirements. This is informational for most practices but may affect patient collections and payment posting workflows.
Action Required
Before January 1, 2025: Billing and collections staff should review the Medicare Prescription Payment Plan details at the provided CMS link to understand how monthly patient billing will work for prescription cost-sharing. Update patient payment collection procedures and patient-facing materials to reflect that Medicare patients may now have monthly prescription payment arrangements rather than full upfront costs at pharmacy. Train front desk and collections staff to recognize and process these monthly billing arrangements correctly. No immediate system changes required, but monitor for changes in how prescription-related patient payments are received and posted.