What is Medicare MP3? AGame-Changer for Biologic Patients in 2025 By David Hartigan

What is Medicare MP3? A Game-Changer for Biologic Patients in 2025 

By David Hartigan, Biologic Coordinator 

As we head into 2025, we know one thing for sure—new challenges are coming. And for patients on Medicare, these changes could be significant. 

In late October 2024, discussions began about upcoming Medicare reforms that would affect Patient Assistance Programs (PAPs), particularly for biologic medications. One of the biggest shifts? The launch of the Medicare Prescription Payment Plan (MP3) on January 1, 2025—a program designed to ease the financial burden for Medicare patients facing high out-of-pocket costs for specialty medications. 

But what exactly is MP3, and how does it impact patient access? Let’s break it down. 

The Challenge: Lower PAP Income Limits & Medicare Patients at Risk 

The changes started with a bang in October, when many biologic manufacturers reduced their PAP income ceilings by nearly 50%. Suddenly, more patients were getting denied for assistance, including Medicare beneficiaries who previously qualified. 

As a Biologic Coordinator, I knew I had to act fast to find solutions. After speaking with multiple pharmaceutical reps, I uncovered a critical Medicare update that had been passed into law in 2022 but never fully implemented—until now. 

This update introduced a $2,000 annual out-of-pocket cap for Medicare patients—a major win in theory, but with one big catch: 

🔹 The full $2,000 could be due upfront when filling a specialty medication. 

For many patients, this lump-sum payment was simply not realistic. That’s where the MP3 program comes in. 

What is Medicare MP3? A New Way to Manage Specialty Drug Costs 

The Medicare Prescription Payment Plan (MP3) is a game-changer for Medicare patients who need specialty medications but don’t qualify for traditional PAPs. 

Instead of facing a single $2,000 bill upfront, MP3 allows patients to break this cost into manageable monthly payments—about $167 per month, depending on their enrollment date. 

✅ Key Benefits of MP3: 
✔️ Eliminates the financial shock of a large upfront payment 
✔️ Allows patients to spread costs throughout the year 
✔️ Keeps medications affordable even if PAP assistance is denied 
✔️ Provides peace of mind for continued therapy 

For Medicare patients struggling with PAP denials, this program could be the best thing since the iPhone (yes, I tell my patients that!). 

Who Should Enroll in MP3? 

MP3 is designed for Medicare patients who: 
✔️ Do not qualify for PAP due to income limitations 
✔️ Need specialty medications but face high out-of-pocket costs 
✔️ Want a structured, manageable payment plan 

Here’s what the process looks like in real life: 

1️⃣ Submit a Prior Authorization (PA) as usual. 
2️⃣ If approved, check the copay amount—Medicare patients may still owe thousands. 
3️⃣ If denied, submit for PAP assistance and request a hardship review. 
4️⃣ If PAP is also denied, introduce the MP3 program as an alternative. 
5️⃣ Help the patient contact Medicare to enroll in MP3. 
6️⃣ Once enrolled, submit the prescription with a note indicating MP3 enrollment to the specialty pharmacy. 
7️⃣ The patient pays nothing at the pharmacy, as long as MP3 payments are active. 

🎯 Pro Tip: Be upfront with patients—we are not insurance agents, but we are here to guide them. Clarity and transparency build trust! 

How to Explain MP3 to Patients (Without the Confusion!) 

Let’s face it—insurance is complicated. Many patients feel overwhelmed by the terminology and process. That’s why I explain MP3 in simple terms: 

💬 "Think of MP3 like a monthly premium. As long as you keep up with your payments, your medication is covered 100% for the year." 

Most patients find comfort in this straightforward approach. Additionally, I always: 
✔️ Provide the Medicare customer service number to save them the hassle of searching. 
✔️ Encourage them to call right away—the sooner they enroll, the sooner we can move forward. 
✔️ Let them know we will resubmit their script to the specialty pharmacy once enrolled for a seamless process. 

📌 Pro Tip: When sending the prescription to the pharmacy, include a note stating the patient is enrolled in MP3. This avoids unnecessary delays. 

Final Thoughts: The Future of Biologic Access for Medicare Patients 

As biologic coordinators, we are on the frontlines of patient access challenges. Programs like MP3 can make a huge difference for Medicare patients who might otherwise be unable to afford life-changing medications. 

Many pharmaceutical companies are now developing patient-friendly MP3 handouts, and patients who have gone through the process report it was surprisingly easy once they called Medicare. 

2025 may bring new challenges, but with MP3, we have one more tool to ensure patients continue to receive the care they deserve. 

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At BC Educators, we are dedicated to empowering biologic coordinators, healthcare professionals, and patient advocates with the education, tools, and resources needed to optimize patient care. From expert-led webinars to hands-on training, we provide comprehensive support to help you navigate the ever-evolving landscape of specialty medications and prior authorizations.

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