Did You Know That Medicare Part D Patients Are Not Restricted to the
Pharmacy Listed on Their Insurance Card?
The beginning of a new year can be confusing when it comes to your health insurance benefits because they have either changed or reset. You may have even received a new card. But did you know that you are not always limited to the specialty pharmacy listed on the back of your insurance card?
If you are a Medicare Part D Patient, many pharmacies can be considered in-network.1 If Onco360 is not listed on your card and you would like us to fill your prescriptions, tell your doctor we are your preferred pharmacy. You can also contact us and we can reach out to your doctor to get the process started.
BIG Benefit Changes Are On The Way for Medicare Part D Patients in 2025
Great news! There are two big changes in 2025:
- The out-of-pocket prescription drug costs will be decreasing to a $2,000 maximum cap for the year.
This includes all part D prescription medications – brand and generic - New for 2025 – the Medicare Prescription Payment Plan (MPPP)
The MPPP is a new payment option that works with your current drug coverage to help you manage your out-of-pocket Medicare Part D drug costs by spreading them across the calendar year (January-December). Starting in 2025, anyone with a Medicare drug plan or Medicare health plan with drug coverage (like a Medicare Advantage Plan with drug coverage) can use this payment option. Enrollment in the MPPP is voluntary, and you will have the opportunity to sign up during open enrollment or any time throughout the year.
What Can Medicare Part D Patients Expect with the New Benefit Changes?
The changes for 2025 will make medications more affordable since the out-of-pocket cost is decreased. And since we know specialty medications can be very expensive, it may seem helpful that you can pay your $2,000 over the course of the year; however, the MPPP might not be the right decision for you.
If you have received funding or financial assistance in 2024, and your financial situation has not changed, then you can expect that you will receive funding in 2025. Our recommendation is that you do not enroll in the MPPP until we receive your first prescription in 2025. We will review your out-of-pocket prescription costs and assess your need for financial assistance. At that time, you will be able to determine if enrolling in the payment plan would be beneficial.
If you have concerns about the cost of your medications, contact our OncoAdvocate® Team today at 877.662.6633. They are a dedicated team of over 30 associates who are experts at finding third-party funding solutions for qualified patients so they can start therapy quickly.
In 2024, 65% of our Medicare patients had ZERO out-of-pocket expenses for their medications.
If you would like more information for the Medicare changes in 2025, please visit:
Why Choose Onco360?
- Timing is crucial when it comes to your complex treatment plan, and as the specialty medication experts, we will work as your advocate with your physician, insurance company, and others involved in your treatment.
- We will make sure you understand your medications, their dosage, and any potential side effects. Our clinicians and pharmacists are on call 24/7 if you have any issues at 877.662.6633.
- We will ship your medications to you as quickly as possible with complimentary overnight shipping to your doorstep.
If you are a provider and would like to refer to Onco360, click below
150.8.1 – Any Willing Pharmacy Requirement https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1PDB.pdf