Medicare Prescription Payment Plan
Manage your out-of-pocket Medicare Part D costs
As a Medicare Part D member you can get help to manage your Medicare Part D drug costs through the Medicare Prescription Payment Plan. This program helps to ensure your yearly total of monthly payments will not exceed the maximum out-of-pocket drug costs, which is $2,100 in 2026. The program is optional and is available if you have Medicare Part D coverage.1 The best part is there’s no cost to join and no interest charged for amounts owed.
The Medicare Prescription Payment Plan does not lower your Part D drug costs or save you money, however, it may help you if you have high costs early in the plan year. Once enrolled, you can use it to spread out your covered Part D medication costs across the rest of the year.
If you opt into the program, you will get a bill each month and will no longer need to pay at the pharmacy when a drug covered by Part D is filled.
Note: The billing statement for this program is separate from the health plan’s premium billing statement (if applicable).
Links
- Employer Plans - Medicare
- Drug and Pharmacy Information
- List of Drugs (Formulary) and Drug Change Notices
- Find a Pharmacy
- Drug Transition Policy
- Prior Authorization, Step Therapy and Quantity Limits
- Drug Coverage Determinations (exceptions) and Redeterminations (appeals)
- Medication Therapy Management Program (MTMP)
- Medication Management and Safety
- Mail Order Service
- Specialty Pharmacy
- Out-of-Network Pharmacies
- Medicare Prescription Payment Plan
Frequently Asked Questions
In 2026 you won't pay more than $2,100 for out-of-pocket Part D covered drug costs. This is true for all who have Medicare drug coverage, even if you haven't joined the Medicare Prescription Payment Plan. The Medicare Prescription Payment Plan simply spreads your costs during the year. Your monthly bill will be based on what you would have paid for any prescriptions you get, plus your previous month’s balance, divided by the number of months left in the plan year.
Members who get their drugs from a specialty or mail order pharmacy can still join the Medicare Prescription Payment Plan. Please be sure to inform your pharmacy that you are participating in the program and verify the cost of your prescription
Yes, your payments could change each month if you fill a new prescription. They could also change if you refill a current prescription. This is because the new out-of-pocket drug costs will be added to your balance and there will be fewer months in the year to disperse the rest of your payments.
For detailed examples and more information about the program, please review our fact sheet PDFs:
Requests made for the upcoming plan year (or in advance of a new plan enrollment with a starting date during a plan year) your application will be processed within 10 calendar days of receipt. Or, it will be processed the number of calendar days before the plan enrollment starts – whichever time period is shorter. You will be alerted if you are approved or denied electronically and/or by mail.
If we need more information to process your request, you will receive notice from your Part D plan within the same timeframes stated above.
Note: If you request to opt-in to the Medicare Prescription Payment Plan during the plan year, your request will be processed within 24 hours. If more information is needed to process the request, your plan will make efforts to collect the needed information.
If cost sharing was paid to the pharmacy before your election request was received, there are certain conditions where your request can be processed faster and/or after the fact. These include:
- If you believe that any delay in filling the prescription(s) due to the 24-hour processing timeframe may jeopardize your:
- Life
- Health
- Ability to regain maximum function
- If you request a retroactive election within 72 hours of the date and time the urgent claim(s) were processed.
Once your Medicare Prescription Payment Plan election has been approved, your plan processes the reimbursement for all cost sharing paid for the urgent prescription(s). Plus, the Payment Plan reimburses any covered Part D prescriptions filled between the date the urgent claim(s) were processed and the date that your election is effective within 45 calendar days of the election date.
If your plan decides that you did not request retroactive election within the required timeframe, you will be alerted of that decision.
- After you opt-in to the program, you will be required to make monthly payments.
- You'll get an itemized invoice each month that details your out-of-pocket cost.
- Any past due balances from prior monthly bills will also be included in your billing statement.
- It is important to make payments timely as your participation in the Medicare Prescription Payment Plan could be terminated if payments are not received within two months of their due date
- You can pay via check, electronic funds transfer or credit card.
- You can also set up monthly recurring payments based on the amounts owed.
- It is important to make timely payments. Your Medicare Prescription Payment Plan terminates if payments are not received within two (2) months of their due date.
- Any past due balances from prior monthly bills are added to your billing statement.
- As stated, it is important to make timely payments. Your Medicare Prescription Payment Plan terminates if payments are not received within two (2) months of their due date.
