Sep 11, 2025
Cynthia Miller, MD, MPH, FACP, | VP, Medical Director, Access Experience Team
Courtney L. Ottoson, MS | SVP Managing Director Market Access
In 2025, Medicare introduced a new payment option designed to help consumers manage their out-of-pocket drug costs. Known as a “copay smoothing program,” the Medicare Prescription Payment Plan (MPPP) had modest uptake. While there may be a variety of reasons for this, one barrier to uptake may have been poor communication of the financial benefit. Designing tools and resources with health and financial literacy in mind may increase the use of this and other programs created to help patients manage costs. That could improve adherence and boost health outcomes.
Virtually No One Understands How Copay Smoothing Programs Work
While the impetus behind the copay smoothing program is to make things easier for consumers, people often find it confusing in practice. The plan helps manage out-of-pocket costs (copays) by spreading them across the calendar year. That seems simple, but unless someone has the same set of recurring prescriptions, the calculations are complicated. A monthly bill consists of the cost of all that month’s prescriptions, plus the balance due after the previous month’s payment, divided by the number of months remaining in the year. So, the bill still fluctuates every month—especially if costly medications are involved—just not as much as it might have otherwise.
To be clear, the program does not lower the cost of drugs or save people money: it helps manage monthly expenses. Consequently, to see true benefits, people need to opt in early in the year, giving the most possible time to spread payments.
There is also billing complexity. Those enrolled in the program pay their drug or health insurance plan rather than paying at the pharmacy, which can feel confusing. The contract has scary language indicating that failure to pay can lead to termination of the plan—which some people may interpret as termination of their Medicare plan.
Finally, the all-encompassing nature of the program has an analogous lack of specificity. The program is available to anyone with Medicare and can be used to pay for any pharmaceutical. All that freedom can be intimidating. How can people decide whether or not to opt-in? Decision paralysis may be the final barrier to signups.
Brands Can Help Increase Enrollment —to Everyone's Benefit
Although there are many potential reasons why people aren’t enrolling, the final one has a simple solution. Because the program isn’t product specific and the government has provided resources, many pharmaceutical manufacturers have not spent money to increase uptake. Perhaps they should start.
Linking resources such as copay smoothing to existing patient support services can help patients get more information in an environment tailored to their needs. This could include product specific resources to help patients and caregivers understand how the program can help them in managing their finances for particularly high-cost drugs.
That benefits manufacturers, too. Enrollment in the program can lead to better medication compliance, which means more—and steadier—sales. Brands can start by helping unravel the complexity of copay smoothing, using the tools of health literacy to alleviate consumer concerns and clarify confusion.
Low Health Literacy Among Both Patients and Caregivers Is a Pervasive Issue
Health literacy is the ability to find, understand, and use health information to make informed decisions. It includes reading, numeracy, digital fluency, and critical thinking. It matters because low health literacy ties to poorer health outcomes and higher costs.
- A 2004–2011 systematic review of 96 studies found that low health literacy is consistently associated with more hospitalizations, increased use of emergency care, and decreased uptake of preventive screenings (eg, mammography, flu vaccines). It led to poorer medication adherence, worse disease understanding, and higher mortality rates, especially among older adults.
- An analysis of Medical Expenditure Panel Survey (MEPS) data from 2005–2008 estimated low health literacy contributes up to $215 billion annually in extra healthcare costs—80% from prescriptions, 18.4% from office visits, and 1.6% from ER visits. The authors posit that individuals with lower health literacy may purchase prescriptions, but not use them optimally, necessitating the purchase of additional medications.
While low health literacy often coexists with factors like poverty, lower education, and limited English proficiency, it is also prevalent among many educated people. The reason: healthcare literature often is written with an assumption of knowledge that lay audiences don’t possess. Whatever the genesis, low health literacy contributes to delayed care, increased emergency use, worse self-care, and system inefficiencies.
Improved Health Literacy Stems From Clear, Easily Understood Content
The primary point of any communication is to transfer information. If the audience doesn’t understand the message, the communication has failed. The following 5 strategies can help readers understand health information quickly and easily. Brands should apply them—but then confirm they have succeeded by testing content in market research. Indeed, ongoing surveys can help iterate platforms and communications throughout their life cycle.
1. Chunk content into short, clear sections
Readers can be overwhelmed by long sentences and unfamiliar words. Write in everyday terms and avoid jargon. Use bullet points, large fonts, and clear headings to help make content scannable. Encourage patients to repeat instructions. Include infographics, videos, or icons to visualize explanations.
Recently, Precision AQ created a brand-specific piece to explain how the MPPP could support financial predictability while taking the product. The piece incorporated icons, simple language, and scenarios that highlighted the benefits of enrolling and the steps to enroll. Of note, a full-page chart compares Medicare Part D costs and benefits with and without MPPP at each phase of coverage. It is easy to follow, allowing patients to feel that they have made an informed decision.
2. Tailor the approach to the audience
Effective communications connect with their audience—so what resonates may vary depending on demographics and cultural preferences. Consider whether multilingual support is needed. Research cultural expectations and stigmas; for instance, in some cultures financial discussions are taboo.
To counter these concerns, Precision AQ created a branded piece around 2025 Medicare changes using patient scenarios to help normalize some of the financial difficulties patients may face. Readers were able to see themselves in those vignettes and to understand the options that may be available to them without having to initiate a conversation.
3. Remember digital exclusion and illiteracy
With the ever-increasing focus on electronic communications, it’s tempting to keep everything online. Yet not everyone has access to computers or other digital resources—and even when they do, they are not always digitally fluent. Even the most intuitive portal or website can seem scary to the uninitiated. This creates an opportunity to link to local support groups or educators.
At Precision AQ we take this approach as best practice. Creating patient materials, such as a recent brand-specific piece explaining the Part D OOP Cap and the Extra Help Program, we include links to digital resources and a phone number to the brand support line; we also try to produce materials both in print and digital form to offer the broadest possible support.
4. Stay in touch
No matter how clear or thorough a set of instructions may be, people will have questions—and no chatbot is as satisfactory as a real person. Providing patient support via chat, video, or phone has an added benefit: it’s a real-time feedback loop that can be used to assess and optimize an approach.
5. Be inclusive of the patient support team
Many patients have family members or others who are helping with care. These caregivers or care partners are also important audiences to remember for all communications. They not only accompany the patient on the treatment journey, often they are providing hands-on care, administering medicines and managing other therapeutic interventions.
A final point: Developing thoughtful materials that help overcome health literacy barriers is a critical step in helping encourage enrollment in the new MPPP—but to truly move the needle, those materials need to be seen. Healthcare touchpoints, including pharmacies, providers, and health plans, can help.
- Pharmacies can provide materials at point of sale
- Providers can discuss MPPP during visits, especially when prescribing high-cost medications
- Health Plans can share materials as part of updates
- Centralized portals can integrate materials to expand learning at key points in the treatment lifecycle
- Libraries, senior centers, and other community organizations can serve as sites for distribution and education
It's Time to Shift the Path for Medicare Co-Pay Smoothing
The MPPP is a well-intentioned innovation stymied by a classic pitfall: complex execution meets low awareness and limited understanding. If brands, providers, and payers want patients to benefit, they must treat communication as a critical part of the solution. That means designing materials that speak plainly, visualize clearly, and support patients and caregivers throughout the journey—not just at the point of prescription.
With the right messaging, the MPPP can fulfill its promise: helping patients stay on treatment and on track financially. By bridging the literacy gap we can open the door to better outcomes for all.
REFERENCES
- Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011 Jul 19;155(2):97-107. doi: 10.7326/0003-4819-155-2-201107190-00005.
- Rasu RS, Bawa WA, Suminski R, Snella K, Warady B. Health literacy impact on national healthcare utilization and expenditure. Int J Health Policy Manag. 2015 Aug 17;4(11):747-55. doi: 10.15171/ijhpm.2015.151.
Contact: Maureen.Hennessey@precisionaq.com