Medicare Prescription Payment Plan (M3P)
- jorge.mandujano
- 1 Overview
Overview
The Medicare Prescription Payment Plan (M3P) is a new payment option that works with a patients drug coverage to help them manage their 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 for drugs covered by Part D.
All Medicare part D plans offer this payment option and participation is voluntary.
To access M3P Print Settings click on, File L. Pharmacy Setup Printing
M3P Print Settings
Action for Likely to Benefit Notice (M3P): Prompt to Print, Print Automatically, Do Not Print/Prompt.
Print/Prompt Likely to Benefit Notice During: Label Printed, Rx is Saved, Verify Data Entry (PV1), Verify Before Fill, Verify Before Dispense, Dispensed in POS/E-Sig.
Note: The prompt always appears in the claim response, regardless of pharmacy settings. If a user selects ‘No’ to not print the notice for a prescription, the prompt will not reappear for that patient that day. On the following day, the prompt will reappear based on pharmacy setup settings until the notice is printed. Only one prompt is shown per eligible patient each day. There is no tracking log, but the notice can be printed manually if necessary.
Transmit Claim - 056 - Likely to Benefit
The insurance plan sends Approved Message Code 056, indicating that the beneficiary may benefit from the Medicare Prescription Payment Plan (M3P), to notify BestRx of the patient's potential eligibility. If a patient receives Code 056 for multiple prescriptions on the same day, only one prompt or print will occur that day. Additionally, pharmacies can manually print the notice from the claim response screen by clicking the 'Print Notice' button.
Multiple Patients POS Transaction 056 Prompt
When multiple eligible patients are processed automatically at the POS with the ‘Dispensed in POS/Esig’ setting enabled, two identical copies of the generic notice are printed for each patient. Notices are not customizable, ensuring that all eligible patients receive the notice.
Transmit Claim - 057
Once a patient is enrolled in the Medicare Prescription Payment Plan (M3P), Code 057 will appear in the claim response the next time the patient incurs a copay of $600 or greater. This code indicates that the beneficiary is participating in the M3P.
When reviewing the claim response, pharmacies can scroll down to see the M3P plan details and click ‘Split Bill’ and be able to select the M3P plan. This will be applicable only to MPPP (M3P) related plans. If there is any issues the details can be entered manually into the insurance plan.
Transmit Claim - 058
If a patient enrolled in the M3P plan becomes unenrolled or coverage is unavailable, a rejection will be received and the M3P plan should reject with the same reject code. This is still under development, and no screenshots are available at this time.
Auto-Process Night Tech
Action for Likely to Benefit Notice Settings
In the pharmacy setup for ‘Action for Likely to Benefit Notice’:
If Prompt is selected, Night Tech will not print notices for eligible patients.
If Print Automatically is selected, Night Tech will print notices for eligible patients without specifying for which patient it is.
Since this feature is still under development, to identify Medicare patients billed with a copay of $600 or greater, refer to Workflow Auto Process/Night Tech Queue and filter for the records.
M3P Manual Print Out
The Likely to Benefit Notice (M3P) can also be printed out manually.
In BestRx Misc. H. Likely to Benefit Notice Select A. Print English or B. Print Spanish
Website: Medicare Prescription Payment Program