The Inflation Reduction Act (IRA) promised big changes for Medicare Part D beneficiaries. Beginning in 2026, patients’ annual out-of-pocket (OOP) costs for Part D drugs are capped at $2,100, and the new Medicare Prescription Payment Plan (M3P) allows them to “smooth” expenses over the calendar year instead of paying large amounts upfront.

These reforms mark important progress, but for many people living with chronic or rare diseases, the reality remains far more complex. Even with a $2,100 cap, people are still responsible for significant OOP costs for treatments not billed under Part D, like infused or specialty therapies, where expenses can be much higher.

Further, enrollment in the M3P program remains extremely low, with only 0.5% of beneficiaries currently participating. This issue is not a reflection of the program’s value, but the barriers to awareness, understanding, and enrollment that prevent people from accessing it.

For the healthcare industry, these gaps carry real consequences. When people can’t afford their medications or struggle to understand their coverage, they are less likely to adhere to treatment. At the heart of this challenge is health literacy—a barrier that too often leaves individuals navigating a complex system on their own.

By supporting trusted partners like patient assistance programs and advocacy organizations, industry stakeholders can work to bridge the Part D knowledge gap and help people access the care they need.

The awareness gap

Without focused education, even the best-designed programs can remain out of reach. The M3P program is a clear example: awareness remains low, and people report confusion about eligibility and difficulty navigating enrollment paperwork. For a patient managing cancer, hemophilia, or another high-cost condition, these barriers are enough to discourage participation. That creates a missed opportunity to avoid large upfront bills at the start of the year.

Since the program’s launch in January 2025, provider and pharmacist engagement has been limited. While CMS directs Part D plan sponsors to conduct outreach and requires pharmacists to notify people at the counter, there is no broader mandate for proactive education. In practice, this leaves too many people without guidance.

People need clear, accessible information about Medicare Part D—what the $2,100 cap and M3P mean, how to enroll, what costs are included, and where limitations remain. These resources must also be shared where people are already connected: providers, pharmacies, patient advocacy groups, and trusted community organizations.

There is an opportunity for the healthcare industry to turn policy into practice, by developing provider-facing resources, offering tailored training, partnering with advocacy and pharmacy associations, and ensuring consistent, clear messaging across all points of care.

Patient assistance and advocacy organizations and pharmacies can raise awareness about M3P and help ensure patients have clear information on how to enroll. Leveraging digital enrollment platforms such as GetMyMeds.com that integrate with pharmacy or provider workflows would further simplify the process, making it easier for patients to opt in at the point of care.

Elevating the patient voice and partnering for impact

Connecting policy efforts to the realities people face requires centering the patient voice. By elevating lived experiences and real-world data, industry leaders can ground their platforms in what matters most, whether through corporate initiatives or advocacy partnerships. For example, inviting patients to share their stories at policy forums or including patient advocates on advisory councils ensures reforms are informed by those directly affected.

Still, no single stakeholder can solve health literacy challenges alone. Progress depends on cross-sector collaboration. When providers, pharmacists, industry associations, and advocacy groups work together, they can reach broader networks, deliver consistent information, advocate for legislative reform, and—just as importantly—gain a clearer understanding of what people are experiencing in real time. Partnerships that integrate feedback, such as co-developing educational resources or piloting community-based workshops, can translate policy into meaningful impact on the ground.

A call for alignment

The Medicare Part D redesign under the IRA puts forth useful tools, but their value will fall short without coordinated action from across the healthcare ecosystem. Ensuring these benefits reach the people who need them most requires clear education, accessible resources, and attention towards lived experience. By closing the awareness and literacy gap around Part D and M3P, there is an opportunity to improve access, strengthen trust, and be a true partner in patient care.

The healthcare industry—providers, pharmacists, patient groups, and policymakers—must play a part in reinforcing consistent information at every step of the patient journey. Without that alignment, people will continue to face barriers that keep them from accessing the very protections these reforms were meant to provide. When people understand their benefits, they stay on treatment – and when people stay on treatment, outcomes improve for everyone.

About the Author

Tiara Green is the president of Accessia Health.