Medicare Changes for 2025

What does this mean for your Medicare Part D patients?

The changes for 2025 are aimed to make medications more affordable since the maximum out of pocket (OOP) has decreased to $2,000. However, since we know specialty medications can be very expensive, Medicare Part D patients will often reach their maximum OOP in January or early in the year. The new MPPP is designed to help spread the copays over the course of the year.

While this might sound like a great option to help lower monthly copay costs, enrollment in the MPPP may not be beneficial for the following patients:

• If they received financial assistance in 2024
• If they are likely to receive financial assistance in 2025
• If they have limited income

We will review your Medicare patients’ medications along with their financial situation to assess the need for funding. Our OncoAdvocate Team® will source funding for patients who cannot afford the $2,000 out of pocket cost. Our goal is for the patients in need to have little to no copay and be able to avoid interruption in their much-needed treatment plan.

If your patient meets the financial assistance guidelines, we will work diligently to obtain funding with our proprietary Funding FastTrack Program.

• Patients are pre-screened by our OncoAdvocate Team®
• Once a patient is eligible for financial assistance, they are automatically enrolled and added to the program.
• When funding becomes available our OncoAdvocates work quickly to secure the appropriate funding.

Additionally, by 2025, certain Free Drug Programs will have changed their eligibility requirements:

• Maximum income limits have decreased
• May need to enroll for the new Medicare Prescription Payment Plan