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Part D Copay Smoothing: Manufacturers Excluded From Financial Reconciliation Process

 
• By Cathy Kelly

Aiming for a threshold that ‘strikes the best balance,’ the final guidance from Medicare requires that plan sponsors and pharmacies use $600, single-prescription cost sharing at the point of sale to identify enrollees likely to benefit from the smoothing program and inform them about the option.

Part D Cost Sharing Can Be Spread Out Over The Year Beginning In 2025 • Source: Shutterstock (Shutterstock)

Manufacturers may not engage in the financial reconciliation process between Medicare Part D plans and beneficiaries as part of the cost sharing “smoothing” program established by the Inflation Reduction Act, according to final guidance by the Centers for Medicare and Medicaid Services.

Key Takeaways

  • Manufacturers can’t insert themselves in the reconciliation process between plans and beneficiaries, final guidance says.

  • Beneficiaries with $600 single script cost sharing bill will be notified about program eligibility at the point of sale

The smoothing program is intended to make it easier for beneficiaries with very high-cost prescriptions to afford their co-pays by permitting monthly installments rather than

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