Your Pharm Aid

Much-needed relief is coming for Medicare Part D (prescription drug plan) enrollees in 2025.

Beginning January 1, all Medicare prescription drug plans will cap prescription copays at $2000 per person annually.  The dreaded Medicare Part D coverage gap or “donut hole” will be eliminated.  Once the $2000 per person maximum is reached, patients will automatically reach “catastrophic” coverage, and will not have to pay anything further out of pocket for the remainder of the calendar year.  This change will likely allow many more patients year-round access to higher-cost medications like GLP1 receptor antagonists, SGLT2 inhibitors and direct oral anticoagulants.  

Also new for 2025 is the Medicare Prescription Payment Plan (MPPP).  This new option allows patients to spread prescription drug payments over the calendar year, rather than paying lump sums at the pharmacy if they so choose—participation in a MPPP is voluntary. Patients electing a MPPP will pay nothing at the pharmacy, and instead will receive a prorated monthly bill directly from the Part D plan.  If patients choose not to participate in a MPPP, they will continue to pay copays at the pharmacy as always, until they reach the $2000 maximum.  After that, they will pay nothing at the pharmacy for covered prescription medications.  ALL Medicare prescription drug plans will offer the MPPP.

It is important to note that the MPPP is intended to help patients manage their monthly expenses only. MPPP participation will not save money or lower drug costs. 

Help remind patients that the amount of their bill may change from month to month, and that timing of enrollment is important.  Opting in to a MPPP early in the calendar year is advised, in order to avoid larger monthly payments later in the year.  Should patients likely incur prescription premiums and copays near or at the new $2000 annual maximum, monthly payments spread over a full 12 months would total up to $167 per month.  Waiting to opt-in to a MPPP later in the year could result in higher monthly payments before reaching the $2000 cap, as payments would be spread out over fewer months.  Patients should visit Medicare.gov for details about how the MPPP works and how monthly payments are calculated. 

To participate in a MPPP, patients must opt-in by contacting their Medicare Part D plan online, by phone or mail.  They cannot enroll at Medicare.gov, and they cannot enroll at the pharmacy. 

Xylazine (sometimes known as tranq, tranq dope, or sleep cut) is a nonopioid sedative veterinary tranquilizer that continues to be increasingly identified as a substance of abuse.  Of additional concern, it is often detected to be contaminated with (or in) illegally manufactured fentanyl (IMF) products, and as a result, in IMF-related overdose deaths.  Analysis of public health data has shown that most xylazine overdose deaths involve IMF.  In addition, recent heroin use, other substance/polysubstance use, as well as overdoses in general are more likely in those also reporting use of xylazine.  Per patients surveyed with known xylazine use, most consumed it via swallowing, snorting, sniffing, or smoking (58.5%) vs. injection (31.7%). 

As already well known, patients often seeking heroin are unknowingly acquiring substances containing IMF.  Combined with that, xylazine is increasingly being detected within these IMF products.  A recent Centers for Disease Control (CDC) analysis found a 276% increase in IMF-involved deaths which also contained xylazine during a period of time between January 2019 - June 2022.  Among adults surveyed who reported ever using xylazine, within the previous 30 days they also reported mis-using prescription opioids (63.4%), IMF (60.6%), and heroin (45.4%). 

Xylazine overdoses do not respond to naloxone since it is not an opioid.  However, given its increasing frequency of being contaminated with IMF, naloxone distribution should be considered in patients with known or suspected xylazine use in the event of an unsuspected overdose.  Identifying these patients at risk can be difficult as they may not always be seeking out care.  Xylazine use is often associated with skin and wound care concerns, as necrotic skin ulcerations can be seen with its use.  These lesions and wounds are most likely related to the drug’s vasoconstricting effects on local blood vessels, and occur regardless of how it was ingested.  Patients may be reluctant to seek care for the treatment of such issues as it is often a sign of substance use.  Ensuring providers create a safe, stigma-free environment for patients in such situations is important.  It is also a critical opportunity to discuss making naloxone available to them for the reasons discussed above.

It is also important to remember that patients are not always seeking IMF, xylazine, or other unknown substances when their primary intention may be to obtain heroin.  This knowledge allows providers to keep a watchful eye for signs of substance misuse, while ensuring appropriate care and safety measures (i.e. naloxone) are provided to patients.

FDA approvals of Novel Drugs this year decreased again: 44 products were considered “New Molecular Entities” by the FDA.  The table includes comments on the products that may have an impact on primary care.  Please note that this list covers new molecular entities, not biologicals.