Key Changes for 2025

Some of the key changes for 2025 for the part D program include:

1. Removal of the Donut Hole (Gap Phase) and Initial Coverage Phase- These 2 are being merged together and will be now referred to as the “Standard Coverage Phase.” This condenses the Part D program from 4 phases to 3 (Deductible, Standard, Catastrophic).
2. The Annual Out of Pocket (OOP) threshold is now $2,000 (changing from the current $8,000) TrOOP.
3. The sunsetting of the Coverage Gap Discount Program (CGDP) and the establishment of the Manufacturer Discount Program. This will impact what drugs receive discounts, how they are counted towards the $2,000 OOP, and who is responsible for the cost beyond the set amount.

Where does Pinnacle Financial Services come in?

Pinnacle Financial Services is a full-service “FMO” that will always keep you in the know on industry changes. Medicare is always changing yearly and it’s best to understand new rules and regulations. Outside of the industry knowledge, Pinnacle has full-service back office support, top-notch training, and the best technology in the business. Don’t hesitate and call us today about an exclusive opportunity to market an IE-SNP product!

Check out the 2025 CMS Final Rule regulations proposed Here.