News from the Blues

Aug. 13, 2025

Medicare Prescription Drug Coverage Creditable/Non-Creditable Letters Available for Groups
Applies to all groups, Medicare

• Groups must notify members of their plan's creditable coverage status by Oct. 15.
• You can help: Letters are available  for your groups to assist with determining whether their prescription drug coverage is creditable or non-creditable.

Details: For group plans, the employer, not Blue Cross and Blue Shield of Texas, is responsible for notifying its group health plan members, as well as notifying CMS of its plan members’ creditable coverage status.

• An annual out-of-pocket maximum will increase to $2,100 from $2,000 in 2025.
• Changes to the liability of enrollees, sponsors, manufacturers and CMS in the new standard Part D benefit design, accounting for the start of negotiated prices taking effect.
• The creation of the Select Drug Subsidy program.

Note: Exhibit 3 in the notices is for plans with integrated deductibles and OOP maximums. Some combinations with an OOP maximum greater than $2,100 will pass due to the medical portion. If a group’s plan does not coincide with one of the deductible/OOP max combinations in the exhibit, they will need to enlist a third party to assist in determining their plan’s creditability.

Background: Creditable coverage is defined by the Centers for Medicare & Medicaid Services as “prescription drug coverage (e.g., from an employer or union) that's expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage.”

Groups that have additional questions about this reporting responsibility can visit cms.gov/CreditableCoverage  for more information.