Member Notices Sent for Rx Member Pay the Difference (MPTD) 2023 Program Updates

Applies to all groups

November 8, 2022

What’s new: As a reminder, in 2023, some operational changes will be made to the MPTD program in efforts to standardize the program and help drive generic utilization.
Background: MPTD requires members who fill a brand name prescription, for which there is an exact generic equivalent, to pay the applicable copay or coinsurance plus the difference in cost between the brand and generic drug. Currently, the MPTD program is being managed differently depending on the line of business, the prescription drug list and plan.
Member notices: Members may be sent a letter PDF 60 days prior to the effective date. Based on claims files and applicable operational changes, we started mailing letters to affected members with a Q1 2023 renewal date in late October 2022. This will continue on a quarterly basis through late July 2023.
If you have any questions regarding these changes, contact your Blue Cross and Blue Shield of New Mexico (BCBSNM) account executive.

To read the full BlueVISION newsletter, log in to Blue Access for EmployersSM (BAESM).