A new year means new healthcare coverage. These changes inevitably affect your patients and, by extension, your independent pharmacy.

2025 is no different, and this year, there are several changes on the horizon.

Among these is the Medicare Prescription Payment Plan, a new payment option from CMS designed to help patients better manage their prescription expenses.

For the purposes of this blog, we’ll refer to the Medicare Prescription Payment Plan as “M3P.”

In its simplest form, M3P makes out-of-pocket prescription costs more predictable for Medicare patents, spreading costs throughout the year. M3P is designed to give patients flexibility and control over their healthcare budgets.

Many patients, though, are still in the dark about M3P and the potential benefits they could reap from it. That’s where you come in.

As an independent pharmacist, you have a unique opportunity to not only educate patients about the program but also walk them through enrollment and implementation. In the process, you can make a meaningful difference in their healthcare experience.

But what is M3P, and more importantly, what does it mean for your independent pharmacy?

Read on to learn more about CMS’s latest program, how it works, and how you can help your patients use it in 2025.

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What is the Medicare Prescription Payment Plan?

The Medicare Prescription Payment Plan (M3P) is a voluntary program available to all patients with a Medicare drug plan or a Medicare Advantage Plan that includes drug coverage.

Instead of paying for prescriptions at the pharmacy counter, enrolled patients receive a monthly bill from their health or drug plan.

This spreads their medication costs evenly across the calendar year, making monthly expenses more predictable.

It's important to note, though, that annual premiums remain the same.

While M3P doesn’t reduce the total cost of prescriptions, it simplifies budgeting for patients by breaking down expenses into manageable payments.

Think of it, then, as a budgeting tool rather than a cost-savings program.

Click here to learn more about the Medicare Prescription Payment Plan.

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How Does the Medicare Prescription Payment Plan Work?

M3P is a relatively straightforward process you can implement in your pharmacy workflow with ease.

When a patient fills a prescription, they won’t pay your pharmacy directly.

Instead, their health or drug plan will send them a monthly bill for their prescriptions.

Your pharmacy will continue to receive payment for prescription claims from the health or drug plan, just as you would under traditional billing methods, but without the immediate patient payment at the point of sale.

While patients will still pay premiums for their plan, their monthly bill will reflect the cost of their medications divided by the remaining months in the year.

That said, it’s important to note that monthly payments may fluctuate if patients add or refill prescriptions, as the cost will be recalculated based on the remaining months of the year.

Despite these adjustments, M3P ensures that annual out-of-pocket costs for covered medications won’t exceed $2,000 starting in 2025.

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What are the Pros and Cons of M3P?

As patients consider M3P, it’s important to understand both the pros and cons of the program. Some of the key advantages of M3P include:

  • Predictable payments: Patients can expect recurring monthly bills and eliminate the financial strain of large, one-time expenses.
  • Improved medication adherence: By removing the burden of upfront costs, M3P may encourage patients to stay consistent with regiments and improve medication adherence. Better adherence means better health outcomes.
  • Convenience: Patients can pick up prescriptions at your pharmacy without worrying about payment at the counter. Not only does this save them time, but it also frees up time in your workflow. It’s a win-win for you both.

Despite these benefits, M3P may not be the best fit for every patient. Some drawbacks include:

  • No cost savings: M3P doesn’t reduce the total cost of medications; it only spreads the expenses over time. Patients shouldn’t expect, then, to see actual cost savings from the program.
  • Limited to covered medications: Only prescriptions included in the patient’s Medicare drug plan are eligible. This may leave gaps in coverage for over-the-counter or non-covered drugs.
  • Adjustable payments: Monthly bills may fluctuate if new prescriptions are added or existing ones are refilled. As a result, predictable payments may become a bit more unpredictable.

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How to Prepare for M3P in Your Pharmacy

Like it or not, M3P is coming to your pharmacy.

To effectively integrate M3P into your workflow and make sure you get the most out of the program, you should take a few steps. Here’s how to get started:

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1. Educate Patients About M3P

Many patients may not be familiar with M3P or fully understand how it works.

Explain the program’s benefits in simple terms. Highlight how M3P differs from traditional out-of-pocket payment systems and address any misconceptions patients may have about the program.

CMS requires you to provide eligible patients with a physical copy of the “Likely to Benefit” notice, except in specific scenarios where an exception applies.

In addition, make sure you highlight potential benefits and drawbacks of the program.

To supplement these discussions, consider offering patients printed brochures or visual aids, or even holding a short Q&A at your pharmacy to make sure that patients have a clear understanding of their coverage options.

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2. Ensure Accurate Billing

M3P relies on clear communication between your pharmacy and the patient’s drug plan.

As such, do your due diligence steps to ensure claims are submitted correctly and reflect the patient’s participation in M3P.

Unlike traditional processes that rely primarily on rejected claims, M3P also relies on paid claims. As a result, make sure you pay close attention to both claims.

Streamlining the billing process is easier with the right pharmacy software.

The best software solutions can simplify claims management, flag errors automatically, and integrate with Medicare plans to reduce manual work.

On this note, reliable software can also help you communicate with insurers, minimize delays, and ensure patients receive their medications on time without unnecessary confusion.

Looking to buy a new software system or switch to one that helps you meet your 2025 goals?

Check out our Compare Software page to consider your options and find the right fit for your pharmacy.

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3. Help Manage Changes in Medication Costs

Sometimes, treatment plans change throughout the year.

When they do, it’s essential to keep patients informed about how these changes might affect their medications and, inadvertently, their bill.

While you aren’t responsible for calculating a patient’s total monthly M3P bill, you can stay up to date on their prescriptions and any changes they might make throughout the year.

If a patient’s medication list is updated — whether it’s because of a new prescription, a dosage adjustment, or a medication discontinuation — make sure you let them know of any potential adjustments to their monthly costs.

This transparency not only helps set realistic expectations for patients, but it also builds trust with your pharmacy.

Similarly, if patients get a cost reduction, they’ll be happy to hear the news from you.

In any case, communication is key when it comes to medication changes.

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4. Provide Guidance on Plan Enrollment

Every plan starts with enrollment; and while it can be a headache, your guidance can make the enrollment process smoother.

Encourage eligible patients to enroll as early as possible in the year.

By starting in January, they can take full advantage of spreading their prescription costs evenly over twelve months and better manage their budgets throughout the year.

However, it’s equally important to support patients who change their plan mid-year.

For example, if a patient switches Medicare drug plans due to an unexpected life event or even just a personal preference, remind them to re-enroll in M3P with their new plan.

Keep in mind that the prior plan sponsor will continue to bill the patient for accrued out-of-pocket costs, while the new plan sponsor will handle amounts accrued under their coverage. This results in separate bills for each plan sponsor.

Communicating this to patients can help them avoid confusion or financial strain during the transition.

On this note, consider providing step-by-step instructions, hosting informational sessions, or sharing materials that explain the enrollment process on social media.

Taking these extra steps can keep your patients informed about M3P, no matter when they decide to sign up.

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5. Be a Resource

Finally, make yourself a resource for all things M3P.

Many patients will have questions about how the program works, from billing and coverage details to how the program integrates with their existing Medicare drug plan.

Make sure that when they have a question, your pharmacy is their go-to for answers.

Make it a priority to stay informed about M3P guidelines and updates so you can confidently address patient inquiries. Some resources to keep on your radar are:

With these resources, you can answer all the questions your patients have. In the process, you can position yourself as an expert on M3P and health more generally.

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What M3P Means for Your Independent Pharmacy

M3P offers several benefits for patients and providers alike.

For patients, it can make medication management more affordable.

For your pharmacy, it can offer an opportunity to highlight your expertise and strengthen your role as a trusted healthcare provider.

One important aspect of M3P to keep in mind is that your billing process may look a little different than it normally does.

While the changes may seem small, the impact on your workflow and patient experience can be significant.

M3P, then, offers a great opportunity to streamline your processes and adapt to new programs that enhance patient care.

To make the most out of M3P, make sure that you and your team are well-trained on the program so you can help patients, address concerns, and ensure a smooth experience for everyone involved.

Take the time to talk with patients, explain the program, and help them decide whether M3P is the right fit for their needs.

On a larger scale, take to social media to share information, promote services, and let patients know that when they need you, you’ll be there.

With a patient-focused approach, M3P can quickly become a cornerstone of the service your pharmacy provides.

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Conclusion

The Medicare Prescription Payment Plan brings a new opportunity to simplify prescription costs for Medicare recipients in 2025.

By spreading expenses across the year, it provides predictability and convenience that many patients value.

Your pharmacy can play a key role in helping patients understand, enroll in, and benefit from this program.

By staying informed and proactive on all things M3P, you’ll not only enhance patient care but also cement your pharmacy’s place as a trusted healthcare provider.

For more information on M3P, visit the Medicare website or contact your patients’ health or drug plans directly.