What is it?
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). Starting in 2025, anyone with a Medicare drug plan or Medicare health plan with drug coverage (like CHRISTUS Health Medicare Plus or CHRISTUS Health Medicare Complete) 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 plan to pay for your prescription drugs (instead of paying at the pharmacy). There’s no cost to participate in the Medicare Prescription Payment Plan.
What is the Medicare Prescription Payment Plan?
How does it work?
The new prescription drug law caps your out-of-pocket costs at $2,000 in 2025 and eliminates the coverage gap (known as the “donut hole”). This means you’ll never pay more than $2,000 in out-of-pocket drug costs in 2025. This is true for everyone with Medicare drug coverage, even if you don’t join the Medicare Prescription Payment Plan.
If you do participate in the Medicare Prescription Payment Plan, we’ll let your pharmacy (including mail-order and specialty pharmacies) know that you’re using this payment option. When you fill a prescription for a drug covered by Part D, you won’t pay your pharmacy for the prescription. Each month our Pharmacy Benefits Manager, Express Scripts (ESI) will send you a bill with the amount you owe, when it’s due, and information on how to make a payment. You’ll get a separate bill for your monthly plan premium (if you have one). This payment option might help you manage your monthly expenses, but it does not save you money or lower your drug costs.
Note: Your payments might change every month, o you might not know what your exact bill will be ahead of time. Future payments might increase when you fill a new prescription or refill an existing prescription because as new out-of-pocket drug costs are added into your monthly payment, there are fewer months left in the year to spread out your payments.
How is my monthly bill calculated?
The formula for calculating the minimum monthly payment (referred to as the “maximum monthly cap”) differs for the first month of participation versus the remaining months of the year. The maximum monthly cap calculations include specifics of a participant’s Part D drug costs (previously incurred costs and new out-of- pocket costs), as well as the number of months remaining in the plan year and the amount outstanding. Future payments might increase when you fill a new prescription or refill an existing prescription because as new out-of-pocket costs are added into your monthly payment, there are fewer months left in the year to spread out your payments. As such, the amount can vary from person to person and month to month, with the expectation that the total balance will be completely paid off by January 31st of the next calendar year.
You’ll never pay any interest or fees on the amount you owe, even if your payment is late. Remember, in a single calendar year (January – December), you’ll never pay more than:
- The total amount you would have paid out-of-pocket to the pharmacy.
- The Medicare drug coverage annual out-of-pocket maximum (which is $2,000 in 2025).
View detailed examples of how Medicare Prescription Payment Plan monthly bills are calculated in the Medicare Prescription Payment Plan Fact Sheet.
Who is likely to benefit?
You’re most likely to benefit from participating in the Medicare Prescription Payment Plan if you have high drug costs earlier in the plan year. Although you can start participating in this payment option at any time in the year, starting earlier in the year (like before September), gives you more months to spread out your drug cost. 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. Remember, this payment option might help you manage your expenses, but it doesn’t save you money or lower your drug costs.
This payment option might not be helpful for you if:
- 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 other health coverage.
- 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.
Visit Medicare.gov/basics/costs/help/drug-costs to learn about other programs that can help lower your drug costs.
How can I find out more or sign-up online?
Our Pharmacy Benefits Manager is Express Scripts (ESI). Visit https://express-scripts.calculator.m3p.health for an interactive calculator to estimate your monthly payments and to learn more about the Medicare Prescription Payment Plan program.
Learn more or sign up with ESI online by logging into your Member Portal and clicking "Pharmacy" from the "My Health" drop down menu.