Capital Rx
The Medicare Prescription Payment Plan – M3P – applies to all plan sponsors and fundamentally alters the workflows for pharmacies, pharmacy benefits managers (PBMs), and health plans
New York, NY, March 27, 2024 /PRNewswire/ - Capital Rx, the full-service pharmacy benefit manager (PBM) and pharmacy benefit administrator (PBA) advancing our nation's healthcare infrastructure to improve drug price visibility and patient outcomes, is bringing a standalone, turnkey, end-to-end Medicare Prescription Payment Plan (M3P) solution to the market for Health Plans, Payers, and PBMs offering Medicare Part D. This new solution will facilitate supporting plan members’ ability to pay for their medications as required by the CENTERS for MEDICARE & MEDICAID SERVICES (CMS) guidance.
Capital Rx’s M3P solution within JUDI®, the next-generation enterprise health platform, delivers a suite of capabilities covering billing and reporting, claims adjudication, cost sharing and tracking, program calculations, payment options, and the new pharmacy notifications necessary to meet CMS requirements for M3P, all in a single system. This effectively addresses several challenges Part D sponsors face, including the need to staff up in the call center, billing and enrollment, accounting, pharmacy operations, and other areas of the organization impacted by the new requirements.
Further, Capital Rx’s M3P solution builds on top of modern Medicare reporting to deliver the necessary data for prescription drug events (PDEs) and explanations of benefits (EOBs) to ensure program compliance and in support of CMS data submission requirements.
Modern Healthcare Technology Helps Address Prescription Drug Affordability in the U.S.
It’s no secret that CMS is taking steps to help Americans enrolled in government programs afford the health care they need. Unfortunately, a significant portion of seniors in the U.S. - upward of 25% - find it at least “somewhat difficult” to afford their prescription drugs. The situation is even worse for Black and Hispanic Americans and households with lower income levels. To address this, in addition to capping seniors’ out-of-pocket drug costs, health plan members enrolled in Part D programs will be able to pay for their prescription drugs throughout the plan year, alleviating the burden of potentially high upfront payments at the pharmacy counter, starting on January 1, 2025, thanks to the M3P.
“With JUDI, our clients can confidently meet all M3P with relative ease,” said AJ Loiacono, Co-Founder and CEO of Capital Rx. “This is the kind of new program that JUDI is tailor-made to meet the requirements of. Our modern technology’s unparalleled flexibility, efficiency, transparency, and accuracy shine in these situations, and we’re looking forward to helping health plans smoothly implement this program so that seniors can afford the medication they need on more flexible payment terms.”
“When new programs are announced, our goal is to move quickly to establish the most efficient workflows and processes to meet regulatory requirements. JUDI allows us to do just that for our clients,” said Jason Barretto, Vice President of Government Program Operations at Capital Rx. “I’ve yet to see a new program announcement or requirement at the state or national level that we, with JUDI, can’t handle.”
Please visit our website for more details about Capital Rx’s M3P solution and answers to frequently asked questions.
About Capital Rx
Capital Rx is a full-service pharmacy benefit manager (PBM) and pharmacy benefit administrator (PBA), advancing our nation’s electronic healthcare infrastructure to improve drug price visibility and patient outcomes. As a Certified B Corp™, Capital Rx is executing its mission through the deployment of JUDI®, the company’s cloud-native enterprise health platform, and a Single-Ledger Model™, which increases visibility and reduces variability in drug prices. JUDI connects every aspect of the pharmacy ecosystem in one efficient, scalable platform, servicing millions of members for Medicare, Medicaid, and commercial plans. Together with its clients, Capital Rx is reimagining the administration of pharmacy benefits and rebuilding trust in healthcare. To learn more, visit capitalrx.com.
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Michael Passanante, Senior Vice President, Marketing & Communications
Justin Venneri, Director of Communications