Drug Benefits and Resources

A new payment option that works with a plan’s current drug coverage to help you manage out-of-pocket Medicare Part D drug costs by spreading them across the calendar year (January-December). Starting in 2025, if you select this payment option, each month you’ll continue to pay the plan premium (if there is one), and will get a bill from the health plan to pay for prescription drugs (instead of paying the pharmacy). Even though you won’t pay for drugs at the pharmacy, you will still be responsible for the costs. If you want to know your drug cost before you take it home, you can call the plan or ask the pharmacist at the pharmacy.

There’s no cost to participate in the Medicare Prescription Payment Plan. Participation is voluntary.

This payment option might help you manage monthly expenses, but it doesn’t save money or lower drug costs. 

It depends on your situation. This payment option might help you manage your monthly expenses, but it doesn’t save you money or lower drug costs. You will benefit from participating in the Medicare Prescription Payment Plan if you have high drug costs earlier in the calendar year. Although you can start participating in this payment option at any time in the year, starting earlier (like before September), gives you more months to spread out your drug costs before year ends. Click here to find out if you are likely to benefit from this payment option.

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

• Yearly drug costs are low.
• Drug costs are the same each month.
• You don’t want to change how you pay for drugs.
• You are eligible for Extra Help from Medicare.
• You are eligible for a Medicare Savings Program.
• You get help paying for drugs from other organizations, like a State Pharmaceutical Assistance Program (SPAP), a coupon program, or other health coverage.

Download this form and follow the instructions. You can also call 1-888-672-7205. 

Once your request is received and reviewed, you’ll be sent a letter confirming your participation into the Medicare Prescription Payment Plan.

This is what happens next: 
1. When you get a prescription for a drug covered by Part D, your plan will automatically let the pharmacy know that you’re participating in this payment option, and you won’t pay the pharmacy for the prescription. Even though you won’t pay for your drugs at the pharmacy, you’re still responsible for the costs. If you want to know what your drug will cost before you take it home, call your plan or ask the pharmacist.

2. Each month, your plan will send you a bill with the amount you owe for your prescriptions, 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).

• You can view sample calculation (page 6) and refer to this Fact Sheet from CMS for more information.
• 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 if you weren’t participating in this payment option.
  • The Medicare drug coverage annual out-of-pocket maximum ($2,000 in 2025).
• The prescription drug law caps your out-of-pocket drug costs at $2,000 in 2025. This is true for everyone with Medicare drug coverage, even if you don’t participate in the Medicare Prescription Payment Plan.

Your billing cycle, invoicing will begin the month following the month that you opt-in to participate. And since you can opt-in any time during the plan year, the payment calculation might change every month. Future payments might increase when you fill a new prescription (or refill an existing prescription) because as new out-of-pocket costs get added to your monthly payment, there are fewer months left in the year to spread out your remaining payments. Each month, we will send you a bill with the amount you owe for your prescriptions, 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). Always pay your health or drug plan monthly premium first (if you have one), so you don’t lose your drug coverage. If you’re concerned about paying both your monthly plan premium and Medicare Prescription Payment Plan bills, see section above for information about programs that can help lower your costs.

We encourage you pay the bill once received so the next month’s bill doesn’t increase due to non-payment. You will get reminders from us if you miss a payment but won’t be charged an interest or fees. After two months of missed payments, we will remove you from the Medicare Prescription Payment Plan and send you a letter to inform. You will NOT be disenrolled from VNS Health EasyCare (please use appropriate branding) plan. You can also leave the Medicare Prescription Payment Plan program at any time, if you feel it is not right for you. If you are removed from the program or you choose to leave the program before making full payments of balance owed, keep in mind:

• If you still owe a balance, you’re required to pay the amount you owe, even though you’re no longer participating in this payment option.
• You can choose to pay your balance all at once or be billed monthly.
• You’ll pay the pharmacy directly for new out-of-pocket drug costs after you leave the Medicare Prescription Payment Plan.

Starting January 1, 2025, you can opt-in to participate in the Medicare Prescription Payment Plan anytime during the calendar year. Remember, this payment option may not be the best choice for you if you sign up late in the calendar year (after September). This is because as new out-of-pocket drug costs are added to your monthly payment, there are fewer months left in the year to spread out your payments.

If you elect to participate in this program in 2025, once your new plan year begins, we will confirm your participation, reach out to you for gathering any missing information or deny your participation by providing a reason for denial within 24 hours after receiving your request. If waiting for 24 hours to fill your prescriptions through the Medicare Prescription Payment Plan program is risky for your health, you may still opt-in to participate in the program, pick up your prescriptions through the pharmacy as needed urgently and request for us to adjust those prescription claims through the Medicare Prescription Payment Plan if you are approved to participate. If these claims were up to three days prior to receiving your participation request, we will re-process your prescription claims and reimburse you for the money you paid at the pharmacy. Once your participation is approved, your pharmacy will be informed to submit your prescription claims through the Medicare Prescription Payment Plan.