The Medicare Prescription Payment Plan (MPPP), part of the Inflation Reduction Act, aims to smoothen Out-of-Pocket (OOP) prescription costs for Medicare beneficiaries by spreading upfront expenses over 12 months. To implement MPPP effectively, health plans and Pharmacy Benefit Managers (PBMs) must adopt advanced technology solutions, including automated billing tools and member self-service portals. This transition from manual processes to tech-driven methods ensures accurate billing, seamless data exchange, timely reporting, and proactive member communication. Health plans and PBMs must invest in automated tools to meet regulatory requirements and enhance member experience.

This report explores MPPP’s objectives and key roles and considerations for health plans and PBMs. It highlights essential components for successful MPPP implementation, such as billing tools, self-service portals, and customer support.

Scope

• Industry: Healthcare
• Geography: North America

Contents

In this report, we:

• Explain the MPPP objectives
• Highlight key roles and considerations for health plans and PBMs to implement MPPP
• Detail essential technology solutions required, including automated billing tools, reporting tools, customer service portal, and member self-service portals
• Outline key performance indicators to assess the effectiveness of implementing MPPP

Membership(s)

Healthcare Payer and Provider Information Technology

Sourcing and Vendor Management