No, this program doesn’t reduce your out-of-pocket drug costs. Instead, it helps to spread out the costs throughout the plan year for members with high drug costs. Paying for high cost-sharing amounts through monthly payments instead of all at once to the pharmacy will improve access to — and affordability of — prescription drugs for some people with Medicare Part D.

You’re most likely to benefit from participating in the Medicare Prescription Payment Plan if you have high drug costs earlier in the calendar year. You can start participating in this program at any time in the year. However, starting earlier in the year (before September) gives you more months to spread out your drug costs.

Go to Medicare.gov/prescription-payment-plan/will-this-help-meto answer a few questions and find out if you’re likely to benefit from this program.

Fill out the participation request form at caremark.com/mppp. Or call 1-855-479-3659 to sign up by phone. For TTY, call 711. You can also print, complete, and mail this request form [PDF]

• Jan. 1–Dec. 31, 2024: If you want to participate in the Medicare Prescription Payment Plan program for 2025, contact us now. Your participation will start Jan. 1, 2025.
• Starting Jan. 1, 2025, you can contact us to start participating in the Medicare Prescription Payment Plan program any time during the calendar year.

You can pay your bill by check, automatic withdrawal from a checking account, credit card, or debit card.

If you miss a payment, we’ll send you a reminder. If you don’t pay your bill by the date listed in that reminder, you’ll be removed from the Medicare Prescription Payment Plan program. You’re required to pay the amount you owe, but you won’t pay any interest or fees, even if your payment is late. You can choose to pay that amount all at once or be billed monthly. If you’re removed from the Medicare Prescription Payment Plan program, you’ll still be enrolled in your Medicare health or drug plan.

Always pay your health or drug plan monthly premium first (if you have one) so you don’t lose your drug coverage. If you’re concerned about paying both your monthly plan premium and Medicare Prescription Payment Plan bills, there are programs that can help lower your costs.

If you think we made a mistake on your Medicare Prescription Payment Plan bill, call us. You have the right to follow the grievance process found in your Evidence of Coverage.

You can leave the Medicare Prescription Payment Plan program any time by contacting us. Leaving won’t affect your Medicare drug coverage and other Medicare benefits. Keep in mind:

• If you still owe a balance, you’re required to pay the amount you owe, even though you’re no longer participating in this program.
• You can choose to pay your balance all at once or be billed monthly.
• You’ll pay the pharmacy directly for new out-of-pocket drug costs after you leave the program.

When you sign up to participate, we’ll process your request within 24 hours. However, if your request is incomplete, we may need to contact you for more information before we can approve your request. If that happens, we won’t deny your request right away. But please respond and provide us the missing information right away.

When you sign up to participate in the Medicare Prescription Payment Plan program, we’ll process your request within 24 hours.

If you have an urgent need, we may be able to make the participation effective sooner if:

• You believe that any delay in filling the prescription(s) due to the 24-hour timeframe to process your Medicare Prescription Payment Plan participation request may seriously jeopardize your life, health, or ability to regain maximum function, and
• You request retroactive election within 72 hours of the date and time the urgent claims were processed, and you paid your cost sharing at the pharmacy.

If the above criteria are met, we’ll process a reimbursement of your cost sharing for the urgent prescription(s) within 45 calendar days. Remember, the Medicare Prescription Payment Plan program might help you manage your monthly expenses, but it doesn’t save you money or lower your drug costs.

If you have limited income and resources, find out if you’re eligible for Extra Help, a Medicare program that helps pay your Medicare drug costs. Visit ssa.gov/medicare/part-d-extra-helpto find out if you qualify and apply. You can also apply with your State Medical Assistance (Medicaid) office. Visit Medicare.gov/ExtraHelpto learn more.

Beginning in 2024, the Extra Help program was expanded so that beneficiaries with incomes up to 150% of the federal poverty line and who meet resource standards are eligible for the full benefit. Prior to 2024, the full benefit was only available to enrollees earning less than 135% of the federal poverty line. In addition, income and resource limits may be higher for beneficiaries in Hawaii than those living in parts of the U.S. Mainland. Applying for Extra Help is free and can be done online or over the phone. Call 1-800-772-1213 Monday through Friday, 8 a.m. to 7 p.m. For TTY, call 1-800-325-0778.

Many people qualify for savings and don’t realize it. To learn more, visit medicare.gov/basics/costs/helpor contact your local Social Security office. Find your local Social Security office at ssa.gov/locator/.

Extra Help can help lower your drug costs. If you qualify, Extra Help may be more helpful to you than the Medicare Prescription Payment Plan program.

Example 1: You take several high-cost drugs that have a total out-of-pocket cost of $500 each month. In January 2025, you join the Medicare Prescription Payment Plan through your Medicare drug plan or Medicare health plan with drug coverage.
Example 1 MPPP.pdf

Example 2: You take several drugs that have a total out-of-pocket cost of $80 each month. In January 2025, you join the Medicare Prescription Payment Plan through your Medicare drug plan or Medicare health plan with drug coverage.
Example 2 MPPP.pdf

Example 3: You pay $4 every month in out-of-pocket costs for a prescription you use regularly. In April 2025, you need a new one-time prescription that costs $613, so your total out-of-pocket costs in April are $617. That same month, before you fill your prescriptions, you decide to participate in the Medicare Prescription Payment Plan through your Medicare drug plan or Medicare health plan with drug coverage.
Example 3 MPPP.pdf