Help with Costs

Generic vs. Brand

Generic drugs are approved by the FDA to be just as safe and effective as brand-name drugs. They both have the same active ingredients, but generic drugs usually cost a lot less. This means you can save money on your prescriptions and still get the same benefits as you would from brand-name medication. Talk to your doctor about whether generic medications are right for you.

90-Day Mail Order (Caremark)

You may save time and money with Caremark’s mail-order service by getting a 90-day supply of certain medications conveniently mailed to your home for the same cost as a 30-day supply. That’s three (3) months of medication for the cost of one (1) month of medication. And you’d have to refill only four (4) times a year instead of 12.

Financial Help with the Medicare Savings Program

Healthfirst Medicare Advantage Members may be able to save money thanks to new expanded eligibility requirements for the Medicare Savings Program. With a new, increased income limit, you may now qualify for extra assistance through the Medicare Savings Program and/or Medicaid. We can help you apply to make sure you get all the savings you’re entitled to.

Elderly Pharmaceutical Insurance Coverage (EPIC) Program and Extra Help

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If you’re a Healthfirst Medicare Advantage member and meet certain income requirements, the EPIC program can help you with Medicare Part D out-of-pocket drug costs and premium payments. You may also qualify for the Extra Help program, which also provides help with paying for your drugs. Click below for more information.

Healthfirst Pharmacy Team (exclusively for Healthfirst Medicare Advantage plan members)

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If you’re a Healthfirst Medicare Advantage plan member, our Healthfirst Pharmacy Team can help you figure out how to possibly reduce your out-of-pocket costs for your medications. We can also help you with refill reminders or any other challenges you may have getting your prescriptions.

If you’re a Healthfirst Medicare Advantage member, call 1-844-347-2955 for more information.

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 completely voluntary.

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.

If you would like to participate in the Medicare Prescription Payment Plan:

  • 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.
Medicare Prescription Payment Plan Participation Request Form
  • 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, you 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 into the Medicare Prescription Payment Plan. In that case, you can get retroactive coverage if you meet the following criteria:

  • Your health would’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 and 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).