A recent study has evaluated how the Medicare Prescription Payment Plan (M3P), introduced in 2025 under the Inflation Reduction Act, may affect cancer patients enrolled in Medicare Part D who face high out-of-pocket prescription drug costs. The plan allows beneficiaries to spread their out-of-pocket (OOP) payments throughout the year instead of making large payments at the start.
Researchers used 2022 Medicare claims data from a national sample of cancer patients to assess when individuals typically reach their catastrophic coverage cap and modeled how M3P could change these payment patterns. The findings indicate that nearly half of Medicare Part D beneficiaries with cancer are expected to reach the annual OOP cap, with about one-third doing so as early as January 2025. This results in significant upfront expenses for many patients.
The study found that enrollment in M3P, which spreads OOP costs more evenly over the year, substantially reduces monthly payment fluctuations for those who reach catastrophic coverage early. This approach could help address issues such as delayed treatment initiation, medication nonadherence, financial distress, and poorer health outcomes among patients on fixed or limited incomes.
However, awareness and participation in M3P remain low. According to estimates from the Centers for Medicare and Medicaid Services (CMS), only 6% of Part D beneficiaries—about 2.4 million people—could benefit from enrolling in M3P.
Aryana Sepassi, PharmD, MAS, assistant professor of clinical pharmacy at the University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences and her colleagues suggest that "making the program automatic, rather than opt-in, could significantly expand its impact, reduce financial burden for vulnerable patients, and support more consistent adherence to life-sustaining cancer therapies."
The research was published on January 15, 2026 in the Journal of Clinical Oncology.
