Medicare Prescription Payment Plan

Medicare Prescription Payment Plan participants will pay $0 at the pharmacy for covered Part D drugs, and the Part D plan sponsor will then bill program participants monthly for any cost-sharing they incur while in the program, helping to manage high-cost drugs by spreading payments over time. This program is voluntary, and any eligible members can choose to opt into the program during the Annual Enrollment Period and throughout the plan year online, by phone, or mail.

Program Eligibility

  • Available to anyone covered by Medicare.
  • Current Medicare beneficiaries can sign up during the Open Enrollment Period (OEP) beginning October 15, 2024 for benefits starting January 1, 2025.
  • For individuals who become Medicare eligible after January 1, 2025, Medicare Prescription Payment Plan election can happen as soon as becoming covered by Medicare.
     

Benefits to participant

  • Expense management.
  • Easy to use.
  • Improve health and adherence.
  • No cost to sign up–no monthly fees, no interest, and no late payment fees.
  • If a member opts in to Medicare Prescription Payment Plan, instead of paying a cost-share up front or a potentially large lump sum, the participant will receive a monthly bill with payments spread over the course of the year.
  • View and manage payments – the participant can set up auto pay.
  • Spreading the cost over time allows for access to medication leading to better health outcomes. 
     

Likely to Benefit / Not Benefit

  • Medicare members with higher Part D drug spend. 
  • Prescriptions with a cost share greater than $600 will receive point-of-sale directions. 
  • Those who may be likely to be benefit will be notified by email or mail or at the pharmacy. 
     

 The program may not be the best option if:

  • No Part D drug costs, or low costs annually.
  • Same costs each month. 
  • Late in calendar year. 
  • Receives or is eligible to receive extra help from Medicare or Medicare Secondary Payer (MSP). 
  • If another organization pays a portion of their eligible Part D medications.
     

When and how to elect Medicare Prescription Payment Plan:

  • A member enrolled in a Medicare plan will receive an ID card by mail along with information on how to elect the Medicare Prescription Payment Plan with Express Scripts by phone, website or mail.
    - To enroll by phone or ask questions please call 1.866.845.1803. 
  • To enroll online please use this link esrx.com/mppp.
  • To enroll by mail please complete the required form for English | Spanish.