PBMs processing Medicare Part D claims have reached out to NCPA reporting low compliance for claims to the BIN/PCN that starts with "MPPP…" when a patient is participating in the Medicare Prescription Payment Plan. If your pharmacy receives paid claim responses from Medicare Part D plans with Approved Message Code 057 Beneficiary participating in Prescription Payment Plan, you must send a subsequent claim for the copay amount due to the Part D plan's MPPP processor. If the Patient Pay Amount is $0 due to a supplemental payer it is not necessary, but choosing not to submit the $0 claim may trigger outreach by the PBM to confirm.
Patients may need additional information about the new program. Once they participate, all copays must be submitted to the MPPP processor. Patients who no longer wish to participate should contact their plan. Contact your pharmacy management system right away if you don't know how to check for Approved Message Code 057, or where to look to find the MPPP processing information in the COB/Other Payer segment. For more information on the MPPP, including a continuing education program for pharmacists and pharmacy technicians, go to https://ncpa.org/medicare.
NCPA has also heard from members that Part D plan member hotlines are providing confusing information about MPPP and are also using the encounter to steer patients into mail order from an affiliated mail-order pharmacy. Click here for tips on making formal complaints to Medicare.
