Medicare Prescription Payment Plan

A new way to help manage your prescription costs

The Medicare Prescription Payment Plan can help you manage your out-of-pocket Part D drug costs by spreading them across the calendar year (January-December). It’s optional and free of charge.

The payment plan may be beneficial for members who have high out-of-pocket prescription drug costs early in the year. Watch this video to learn more.

What is the Medicare Prescription Payment Plan?

Starting in 2025, you won’t pay more than $2,000 out-of-pocket for covered Part D prescription drugs.

If you take high-cost Part D drugs, you may reach the spending cap and pay the full $2,000 early in the year. This is where the new Medicare Prescription Payment Plan might benefit you. If you opt in to the payment plan, you will be able to spread your out-of-pocket costs across the calendar year versus having to pay it all within the first few months.

Let’s look at one of our members, John. He takes a high-cost prescription drug for his chronic heart condition. It makes sense for John to opt in to the payment plan beginning in January because he’ll reach his annual $2,000 out-of-pocket limit by April. The payment plan will help John smooth out his costs over the course of the entire year, allowing him to make smaller payments each month.

Please see the FAQ below for more detailed examples or visit the Medicare website to learn more. You can also access the fact sheet for more information.

Medicare Prescription Payment Plan Chart

How does the payment plan work?

The Medicare Prescription Payment Plan is voluntary and free of charge. If you opt in to the payment plan, you won’t pay for your Part D prescription drugs at the pharmacy, or when they’re shipped. Instead, our pharmacy partner, CVS Caremark^®, will send you a bill each month. The total amount due will be based on the Part D prescription drugs you filled that month, plus your previous month’s balance, divided by the number of months left in the plan year. You’ll make your monthly payments directly to CVS Caremark.

Note: The Medicare Prescription Payment Plan might help you manage your expenses, but it doesn’t save you money or lower your drug costs.

Please visit the Medicare website to learn about programs that can help lower your prescription drug costs.

How do I know if the payment plan is right for me?

It depends on your situation. If you’re likely to reach the $2,000 out-of-pocket cap early in the year, and you opt in to the payment plan early, before you fill many prescriptions, it might benefit you. Please see the FAQ below for some examples.

How do I opt in to the payment plan?

To sign up, please log in to your CVS Caremark account. If you don’t have an account, you can create one here. After you’re logged in, go to go to the Medicare Prescription Payment Plan program page.

You can also call our dedicated prescription help line at 1-855-222-3183 (TTY:711) to sign up. For more detailed information, please see the FAQ below.

Frequently Asked Questions

Getting started

Who is most likely to benefit from the payment plan?

The Medicare Prescription Payment Plan is likely to benefit you if:

You have high out-of-pocket costs for your medications
You will reach your $2,000 out-of-pocket cap within the first few months of the year
You want to spread out your pharmacy costs over the course of the year
You have a one-time drug cost that’s high mid-year

Who is not likely to benefit from the payment plan?

The Medicare Prescription Payment Plan 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 signing up for the Plan late in the 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) or a charity

How will my drug costs work with the payment plan?

If you opt in to the payment plan, you’ll make monthly payments to CVS Caremark versus paying at the pharmacy (including mail-order and specialty pharmacies). Your monthly bill will be based on what you would have paid for any prescriptions you get, plus your previous month’s balance, divided by the number of months left in the year.

It’s important to note that the amount you owe each month could change. For example, if you get a new prescription, your monthly payments may go up. This is because the additional costs for the new medication need to be included in your monthly payments, and since there are fewer months left in the year, the remaining payments need to cover these costs. No matter how much you owe each month for your Part D medications, the total amount you will pay of out-of-pocket during the entire year will not be more than $2,000.

Can I see examples of how the payment plan may or may not benefit me?

Absolutely.

This first example shows what a member might pay if they have high drug costs early in the year:
M3P Payment Example 1.

This second example shows how a member who has consistent drug costs each month might not benefit from the payment plan:
M3P Payment Example 2.

This third example shows how a member might benefit from opting in to the payment plan mid-year to avoid having to pay a one-time drug cost that’s high:
M3P Payment Example 3.

If I qualify for financial assistance, will the payment plan still benefit me?

If you qualify for financial assistance, it’s likely you’ll benefit more from enrolling in the Extra Help, Medicare’s Part D low-income subsidy (or LIS) program.

Who can help me decide if I should opt in to the payment plan?

If you have questions, please don’t hesitate to call our 24/7 dedicated prescription help line at
1-855 222 3183.

Opting in and out

How do I opt in to the prescription payment plan?

To sign up, please log in to your CVS Caremark account. If you don’t have an account, you can create one here. After you’re logged in, go to the Medicare Prescription Payment Plan program page.

You can also call our dedicated prescription help line at 1-855-222-3183 (TTY:711) to sign up.

I just opted into the plan, but I need my medication now. What should I do?

There is a 24-hour processing period before you’re fully enrolled in the plan. If you believe waiting the 24 hours to fill your prescription is a serious risk to your health, pay for your prescription out-of-pocket, call 1-855-222-3183 (TTY:711) and request urgent retroactive enrollment into the plan and you will be reimbursed within 45 days of submitting the request.

If I choose to opt out of the payment plan, can I join again in the future?

Yes. If you sign up for the payment plan and then decide to opt out, you can join again in the future. Simply log in to your CVS Caremark account. If you don’t have an account, you can create one here. You can also call our dedicated prescription help line at 1-855-222-3183 (TTY:711) for assistance.

I just paid a high cost for an urgent prescription fill. Can I opt in to the program and cover the cost that I already paid?

Yes, if you just paid for a part D prescription that you consider urgent (not taking it could cause a serious risk to your health), you can opt into the plan retroactively. You must request retroactive enrollment within 72 hours of paying for your prescription out-of-pocket. To submit a request to opt in retroactively, call 1-855-222-3183 (TTY:711).

Payments

When are payments due?

Payments for the Medicare Prescription Plan are due on the 25th of each month. Your payments should not be made to Sharp Health Plan. They should be made to CVS Caremark directly.

What happens if I don’t pay my monthly bill?

If you miss a payment, you’ll get a reminder from CVS Caremark. If you don’t pay your bill by the date listed in that reminder, you’ll be removed from the Medicare Prescription Payment Plan, and you’ll pay the pharmacy directly for any out-of-pocket drug costs.

You will be required to pay CVS Caremark the amount you owe, but you won’t pay any interest or fees, even if your payment is late. If you’re removed from the payment plan, your Medicare drug coverage and other Medicare benefits won’t be affected, and you’ll continue to be enrolled in benefits with Sharp Health Plan as long as you continue to pay your monthly plan premium (if you have one).

If I’m removed from the payment plan due to nonpayment, can I join again in the future?

Yes. Once you’ve paid the total amount you owe, you can opt in to the program again by logging in to your CVS Caremark account. If you don’t have an account, you can create one here. You can also call our dedicated prescription help line at 1-855-222-3183 (TTY:711) for assistance.

Financial help

I have limited income and resources. What programs can help lower my drug costs?

Many people qualify for savings and don’t realize it. Below is a list of programs that are available. You can also contact your local Social Security office to learn more.

Extra Help: A Medicare program that helps pay your Medicare drug costs. Visit Medicare’s website to find out if you qualify and apply. You can also apply with your State Medical Assistance (Medicaid) office.
Medicare Savings Programs: State-run programs that might help pay some or all of your Medicare premiums, deductibles, copayments, and coinsurance. Visit Medicare’s website 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 Medicare’s website 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 Medicare’s website to learn more.