Medicare & Long-Term Care Medicare Prescription Payment Plan

The Medicare Prescription Payment Plan is a new payment option in the prescription drug law, effective January 1, 2025. While it does not lower your costs, it may help you manage your out-of-pocket Medicare Part D drug costs. The payment plan spreads your costs across the calendar year (January–December) into monthly payments.

If you select this payment option, you will receive a monthly bill from Healthfirst to pay for your prescription drug costs, instead of paying the pharmacy. There is no cost to participate, and it's completely voluntary.

Download the fact sheet

Visit the Fact Sheet links below to learn more, review examples of how the program calculations work, the importance of paying monthly bills, and find out if this program is right for you.

To select this payment option:

Opt-In

Online at caremark.com/mppp

By phone: 1-888-698-0577 (TTY 711)

Or you can print, fill out, and mail a Medicare Prescription Payment Plan Participation Request Form to the address on the form.

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Opt-Out

You can opt out of the program at any time by calling 1-888-698-0577 (TTY 711).

When you opt out of the Medicare Prescription Payment Plan:
  • You will pay your pharmacy directly for all your covered Part D drug costs. (This also applies to mail-order and specialty pharmacies.)
  • You will continue to receive monthly bills for the amount incurred while in the program until your balance is paid, with no added fees or interest.
  • You also have the option to pay the balance in full at any time.
  • If you choose to participate in the program in the future, simply opt in as you did before.

Retroactive election into the Medicare Prescription Payment Plan

Suppose you have urgent prescriptions that need to be filled prior to the 24-hour time frame to process your request for enrollment in the Medicare Prescription Payment Plan. In that case, you can get retroactive coverage if you meet the following criteria:

  • Your health could’ve been jeopardized if your prescriptions were not filled sooner than the 24-hour time frame required to process your request.
  • You must submit your request for retroactive election within 72 hours of the date and time the urgent claims were determined.

Once your Medicare Prescription Payment election is processed, you will be reimbursed by Healthfirst for any cost sharing paid for the urgent prescription and any covered Part D prescription filled between the date of that fill and the date that your election was processed within 45 days of the election date. If you are reimbursed for the urgent prescription, you are still responsible for paying it. That cost sharing will then be applied to your monthly payment plan. If your retroactive enrollment request is denied, you will be notified and can file a complaint or grievance.

If you have any questions, comments, concerns or grievances related to the Medicare Prescription Payment Plan, please call 1-888-698-0577 (TTY 711).

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