New for 2025
New Processing Information
Effective 1/1/2025, Retiree RxCare will have a new BIN (027497) and PCN (CMSPARTD) used to process your prescriptions. Please use your new Retiree RxCare ID Card at your pharmacy.
Important Medicare Part D Changes Coming in 2025
Starting January 1, 2025, there are some big changes coming to Medicare Part D that you should know about. These updates, brought by the Inflation Reduction Act (IRA), are designed to make your prescription drug coverage easier to understand and more affordable. Here’s a quick overview of what you can expect:
New $2,000 Out-of-Pocket Maximum
One of the biggest changes is the introduction of a $2,000 out-of-pocket (OOP) limit for your prescription drug costs. Once you spend $2,000 on covered medications, you won’t have to pay anything more out-of-pocket for the rest of the year. This new cap will help protect you from high drug costs.
Simplified Benefit Structure – No More “Donut Hole”
The “donut hole” or coverage gap will be eliminated in 2025. This means that after you meet your deductible, you’ll pay a flat 25% of your drug costs until you reach the $2,000 OOP limit. This change simplifies how your costs are calculated and makes it easier to predict your spending.
Improved Catastrophic Coverage
Once you hit the $2,000 OOP limit, you’ll enter the catastrophic coverage phase. In this phase, you’ll have consistent cost-sharing throughout the year, helping you better manage your medication expenses.
Medicare Prescription Payment Plan (M3P)
A new option starting in 2025, the Medicare Prescription Payment Plan (M3P), allows you to spread out your drug costs over the year instead of paying all at once. With M3P, you’ll pay $0 at the pharmacy and receive a bill each month for your medications. This option can help you manage your budget more easily.
Changes in Cost Sharing
There are also changes in how the costs are shared between you, the plan, and drug manufacturers:
The federal government will cover less of the cost for brand-name and generic drugs, which means plan sponsors and drug manufacturers will take on a larger share of the costs.
Impact on Enhanced Group Waiver Plans (EGWP)
If you have Part D coverage through an Enhanced Group Waiver Plan (EGWP), those benefits will now count towards your out-of-pocket costs, helping you reach the catastrophic phase sooner. This can lead to more savings on your medications.
What This Means for You
These changes are aimed at making your Medicare Part D coverage more predictable and affordable. With the new out-of-pocket maximum, simplified cost structure, and options like M3P, managing your prescription drug costs should be easier than ever.
Stay Informed
We’re here to help you navigate these changes and understand how they affect your coverage. Keep an eye on your mail and this website for more information as the new year approaches. If you have any questions or need assistance, don’t hesitate to reach out to us. We’re committed to supporting you every step of the way.
Together, we’ll ensure you’re ready for the changes in 2025 and continue to make the most of your Medicare Part D benefits.
Helpful Links
Inflation Reduction Act - Click to leave site
Medicare Prescription Payment Plan (M3P)- Click to leave site
