Medicare Prescription Payment Plan- Part D Rx
The Medicare Prescription Payment Plan is a new payment option in the prescription drug law that works with your current drug coverage to help you manage your out-of-pocket Medicare Part D drug costs by spreading them across the calendar year (January-December). Anyone with a Medicare drug plan or Medicare health plan with drug coverage (like a Medicare Advantage Plan with drug coverage) can use this payment option. All plans offer this payment option and participation is voluntary.
If you select this payment option, each month you’ll continue to pay your plan premium (if you have one), and you’ll get a bill from your health or drug plan to pay for your prescription drugs (instead of paying the pharmacy). There’s no cost to participate in the Medicare Prescription Payment Plan.
How do I sign up?
There are three different ways that you can sign up for the Medicare Prescription Payment Plan:
- Log into the Express Scripts website at www.express-scripts.com/mppp using the same username and password you typically use. If you do not have an Express Scripts online account, you may also create one, by clicking the Register now link.
- Log into the Express Scripts app on your phone.
- If you prefer to talk to someone, you may call THP Pharmacy Services at 1-800-624-6961, ext. 7914 (TTY: 711) or call Express Scripts directly at 1-866-845-1803 (1-800-716-3231 for hard of hearing).
- You may also mail general questions to:
Express Scripts Medicare Prescription Payment Plan
P.O. Box 2
Saint Louis, MO 63166
Here are some things you need to know about the Medicare Prescription Payment Plan:
You are most likely to benefit from the Medicare Prescription Payment Plan if you have high drug costs earlier in the year. However, you can start participating at any time. You may not benefit if your yearly drug costs are low, if your drug costs are the same each month, or if you get help paying for your drugs such as through Extra Help from Medicare.
Medicare’s Part D Low Income Subsidy (also called LIS or Extra Help) can help reduce costs for individuals who qualify based on income and resource limits. The Extra Help program was expanded in 2024. So, if you weren’t eligible for Extra Help in the past, you may be eligible now. You should check if you think you may be eligible. You can still join the Medicare Prescription Payment Plan if you are eligible for Extra Help, but most people eligible for Extra Help are less likely to benefit from the Medicare Prescription Payment Plan.
If you have limited income and resources, find out if you’re eligible for one of these programs:
• Extra Help: A Medicare program that helps pay your Medicare drug costs. 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.
• Medicare Savings Programs: State-run programs that might help pay some or all of your Medicare premiums, deductibles, copayments, and coinsurance. Visit Medicare.gov/medicare-savings-programs to learn more.
• State Pharmaceutical Assistance Programs (SPAPs): Programs that might include coverage for your Medicare drug plan premiums and/or cost sharing. SPAP contributions may count toward your Medicare drug coverage out-of-pocket limit. Visit go.medicare.gov/spap to learn more.
• Manufacturer Pharmaceutical Assistance Programs (sometimes called Patient Assistance Programs (PAPs)): Programs from drug manufacturers to help lower drugs costs for people with Medicare. Visit go.medicare.gov/pap to learn more.
No. You will pay the same amount. This payment option just helps you spread out your drug costs over time.
No. Election into the Medicare Prescription Payment Plan is voluntary. You do not have to join.
No. There are no fees or interest charged. This payment option does not reduce the amount of your cost sharing. It just spreads the costs into monthly payments rather than paying your cost share all at once at the pharmacy.
The maximum cost sharing for Part D prescriptions in 2025 is $2,000. This maximum amount is the same whether or not you choose to participate in the Medicare Prescription Payment Plan.
The attached fact sheet includes examples on how your monthly payments will be calculated.
It is important that you pay your monthly bill. If you do not, you may be removed from the Medicare Prescription Payment Plan. If you don’t pay your bill, we will write you a letter to remind you. If you don’t pay your bill by the date listed in the reminder, you will be removed from the Medicare Prescription Payment Plan.
You will still be required to pay the amount that you owe. You can choose to pay all at once or in monthly payments. You will still be enrolled in your Medicare plan even if you are removed from the Medicare Prescription Payment Plan.
If you want to join the Medicare Prescription Payment Plan before the effective date of your enrollment in the Medicare plan, we must complete your election within 10 days or before the effective date of your Medicare Plan, if less than 10 days. If you want to join the Medicare Prescription Payment Plan after the effective date of your Medicare plan, we must complete your election into the Medicare Prescription Payment Plan within 24 hours.
No. You must use one of the ways described above to sign up for the Medicare Prescription Payment Plan.
If a delay in filling your prescription may jeopardize your health, you can request a retroactive election into the program within 72 hours of the date and time you pick up your prescription. You can contact us using the information above and let us know you want to join the program retroactively. We will then reimburse you for the amount you paid at the pharmacy and start billing you in monthly payments for the cost sharing amount of your Part D prescriptions. To do this, you must notify us within 72 hours from the time you picked up your prescription.
You can opt out of the Medicare Prescription Payment Plan at any time by contacting us using the contact information listed above. If you opt out of the Medicare Prescription Payment Plan, we will continue to bill you monthly for any amounts that you owe. You can also choose to pay us all at once. After opting out of the Medicare Prescription Payment Plan, you will pay any new cost sharing amounts directly to the pharmacy.
You can call us using the contact information above or call The Health Plan’s customer service line at 1-800-624-6961, ext. 7914 (TTY: 711)
For more information, please see the attached fact sheet. You can also get more information at https://www.medicare.gov/prescription-payment-plan.