M3P made easy with Judi
Handles payments, collections, PDEs, CMS reporting, and accepts all major payment methods.
Tracks member spending and simplifies enrollment through multiple channels.
Alert pharmacies when enrollees can benefit from the program.
Judi automatically updates the maximum monthly cap threshold for M3P compliance.
All-in-one M3P solution
Capital Rx powers health plans, payers, and PBMs with a complete M3P solution that handles billing, claims, cost tracking, payments, and pharmacy alerts, providing everything needed to meet CMS requirements in one seamless system.
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Expertise for M3P program success
Capital Rx is the premier pharmacy benefits administrator that provides all the disciplines necessary to make a health plan's M3P Program a success.
This solution effectively addresses several challenges Part D sponsors face, including the need to staff up in the call center, billing and enrollment, accounting, pharmacy operations, and other areas of the organization impacted by the new requirements.
FAQ
Frequently asked questions
What is the Medicare Prescription Payment Plan (M3P)?
The Medicare Prescription Payment Plan (M3P) is a significant step towards improving prescription drug affordability for Medicare beneficiaries.
This program allows Medicare Part D members to spread their out-of-pocket Part D prescription drug costs throughout the plan year, alleviating the burden of high upfront payments at the pharmacy.
Does this provision apply to all Part D sponsors?
This provision applies to Part D sponsors, including stand-alone Medicare prescription drug plans (PDPs) and Medicare Advantage (MA) plans with prescription drug coverage (MA-PDs), as well as Employer Group Waiver Plans (EGWPs), cost plans, and demonstration plans.
Not all Part D plans are required or eligible for the program. LI NET, PACE, and MMP are excluded from the M3P.
What types of drugs does the Medicare Prescription Payment Plan cover?
All covered Part D drugs are included in the program. Part D sponsors may not exclude any covered Part D drugs, and once a Medicare Part D enrollee has opted in, all their out-of-pocket Part D prescription drug costs will be billed monthly, as required, while they are in the program.
Will opting into the program change anything about Part D benefits?
No, total out-of-pocket Medicare Part D drug costs will not change. Opting into the program will not affect how people with Medicare move through the Part D benefit or what counts toward their deductible or annual out-of-pocket cost threshold.
The only difference is how and when payments are made (monthly payments to the plan instead of at the pharmacy).
How will Part D enrollees benefit under the Medicare Prescription Payment Plan?
Enrollees will be able to pay high cost-sharing amounts monthly instead of all at once at the pharmacy, improving affordability and access to drugs. This will help participants manage high-cost drugs by spreading out the costs over time.
Are individuals in the Extra Help program eligible for the Medicare Prescription Payment Plan?
Yes, Part D sponsors must provide ALL Part D enrollees with the option to opt into the M3P program, including those in the Extra Help program.
