Medicare Prescription Payment Plan

Beginning in 2025, you now have the option to be billed on a monthly basis for your Part D prescription drug costs, rather than paying for them at the point of sale at your pharmacy. This program, called the Medicare Prescription Payment Plan, is voluntary and is offered by all Part D prescription drug plans.

Important: This payment option helps you manage your monthly expenses, but it doesn’t save you money or lower your drug costs 

Members who are most likely to benefit are those who incur high out-of-pocket drug costs earlier in the plan year. As a reminder, your out-of-pockets Part D prescription drug costs are capped at $2,000.

Read on for more details about the program, including how to determine if you are likely to benefit and how to enroll.

How it works

After enrolling in the program, you pay $0 for your Part D prescription drugs at your pharmacy (includes all types of pharmacies, including mail order). We pay the pharmacy as usual and will bill you monthly for any out-of-pocket costs you incurred since enrolling in the program. This program only applies to Part D-covered drugs, so if you take drugs covered under Part B or our supplemental benefit, you will continue to pay for those at the pharmacy.

The Medicare Prescription Payment Plan is free to join. While we won’t charge you any fees or interest, it is important to pay your monthly bills. If you fail to pay your bill in full by the due date, we are required to terminate you from the program after a 60-day grace period. You also have the option to disenroll from the program at any time.

Who is likely to benefit

You’re most likely to benefit from this program if you have high drug costs earlier in the calendar year. If you have a cost-share that is $600 or more for a single prescription drug, we will tell your pharmacy to give you information about the Medicare Prescription Payment Plan.

Although you can start participating in this payment option at any time in the year, starting earlier in the year (i.e. before September), gives you more months to spread out your drug costs. Go to Medicare.gov/prescription-payment-plan/will-this-help-me to answer a few questions, and find out if you’re likely to benefit from this payment option.

This payment option may not be the best choice for you if: 

  • Your yearly drug costs are low
  • Your drug costs are the same each month
  • You’re considering signing up for the payment option late in the calendar year (after September)
  • You don’t want to change how you pay for your drugs
  • You get or are eligible for Extra Help from Medicare
  • You get or are eligible for a Medicare Savings Program
  • You get help paying for your drugs from other organizations, like a State Pharmaceutical Assistance Program (SPAP) (Prescription Advantage in Massachusetts), a coupon program, or other health coverage 

Examples of how a monthly bill is calculated

Medicare has created some examples to help you understand how your monthly bill will be calculated: Examples of this payment option
 

How to enroll

We have partnered with SimplicityRx to offer this program. Enrolling in the program is easy – we recommend completing your request online at Activate.RxPayments.com. You may also enroll by phone, fax, e-mail and mail:

Online (preferred): Activate.RxPayments.com

Phone: 833-696-2087 (TTY 711) 

  • October 1 – March 31, 8am – 1am EST, 7 days a week 
  • April 1 – September 30, 8am – 11pm EST, Monday through Friday

Fax: 440-557-6525

Email: ElectMPPP@RxPayments.com 

Mail:    SimplicityRx
            Mailstop: 1001
            MPPP Election Dept.
            13900 N. Harvey Ave
            Edmond, OK 73013

Once we receive your request to enroll in this program, we will send you a letter confirming your participation. If we need more information or your request is denied, we will also notify you in writing. These communications will be sent 24 hours of receiving your request if your request is made during the plan year. If you are enrolling in this program before 1/1/2025, we will send these communications within 10 days of receiving your request, but no later than 1/1/2025.

If you urgently need a medication and are unable to wait the 24 hours for us to process your enrollment request, we can retroactively enroll you in the program. You must meet the following conditions:

  1. You believe that any delay in filling the prescription(s) due to the 24 hour timeframe required to process your request to opt in may seriously jeopardize your lift, health, or ability to regain maximum function; and
  2. You request retroactive election within 72 hours of the date and time the urgent prescription drug claim(s) was processed at the pharmacy.

Extra Help

The Medicare Prescription Payment Plan does not lower the amount you pay for your Part D prescription drugs. If you have limited income and resources, you can find out if you are eligible for Extra Help, a Medicare program that helps pay your Medicare drug costs. The eligibility requirements for this program have recently expanded, so even if you have not qualified in the past, it may be worth applying again. 

Visit ssa.gov/medicare/part-d-extra-help to find out if you qualify and apply. You can also apply with your State Medical Assistance (Medicaid) office. Visit Medicare.gov/ExtraHelp to learn more.

If your receive Extra Help, the Medicare Prescription Payment Plan is unlikely to benefit you.

For more information

Additional resources about this payment option are available:

You may also contact SimplicityRx at 833-696-2087 (TTY 711), October 1 – March 31, 8am – 1am EST, 7 days a week and April 1 – September 30, 8am – 11pm EST, Monday through Friday

If you are unhappy with the Medicare Prescription Payment Plan, you may file a complaint or grievance. For more information about how to do this, visit: Grievances.