Medicare Prescription Payment Plan
What is the Medicare Prescription Payment Plan?
It’s a new payment option where you can pay out-of-pocket prescription drug costs in the form of monthly payments over the course of your plan year instead of all at once at the pharmacy. It’s completely voluntary to join, meaning it’s your choice. The program begins on January 1, 2025.
How Does It Work?
The goal is to help you manage your out-of-pocket Medicare Part D drug costs by spreading them across the calendar year (January-December). There are no fees or interest if payments are made on time. This payment option may help you manage your expenses, but it does not save you money or lower your drug costs. If you decide to join, you will initially pay $0 to the pharmacy for covered Part D drugs. Then, as the Part D plan, we will bill you monthly for any covered Part D drug cost sharing you get while in the program.
Part D enrollees who face high cost-sharing earlier in the plan year are more likely to benefit from the program. This payment option may not be the best choice for you if you get help paying for your prescription drug costs through programs like Extra Help from Medicare or a State Pharmaceutical Assistance Program (SPAP). Before you make a decision, consider all of your options and what might work best for you. If you have limited income or resources, you can learn more about programs to help lower drug costs by visiting www.medicare.gov.
How Do I Join?
You can opt into the Medicare Prescription Payment Plan:
- Before the beginning of the plan year,
- In any month during the plan year,
- Or during the annual enrollment period, which is October 15 through December 7.
You can also leave this payment option at any time without affecting your Medicare drug coverage and other Medicare benefits.
You can enroll into the program by:
PHONE:
Call our Pharmacy Benefit Manager, Express Scripts, at 1-866-845-1803, 24 hours a day, 7 days a week. TTY users can call 1-800-716-3231. There is no cost to enroll.
ONLINE:
You can also complete the participation request form online at www.express-scripts.com/mppp.
MAIL:
To submit your request by mail,
download the form. Submit the completed form to:
Express Scripts MPPP
P.O. Box 801101
Kansas City, MO 64180-1101
If you have questions or need help, call Express Scripts at 1-866-845-1803, 24 hours a day, 7 days a week. TTY users can call 1-800-716-3231.
NOTE: If your address is different than what is on the form, you will need to work with us to update your address.
Urgent Requests
If you have an urgent prescription and you paid for it before you were accepted into the program, there is a process where we can reimburse you for the cost sharing you paid. We call this a retroactive election. We can only process these reimbursements if all the following conditions are met:
- You believe that any delay in filling the prescription(s) may seriously jeopardize your life, health or ability to regain maximum function. It takes 24 hours to process your request to join the program.
- Your retroactive election request is within 72 hours of the date and time the urgent prescription claim(s) were processed.
Once your election has been confirmed, we will process the reimbursement for all cost sharing you paid for the urgent prescription and any covered Part D prescription filled between the date of the urgent claim and the date that your election is confirmed within 45 calendar days of the election confirmation date.
If we determine you failed to request retroactive election within the required timeframe, we will promptly tell you of our decision and give you instructions on how to file a grievance.
What Happens Once I Join?
We will tell your pharmacy:
Once you have been accepted into the program, we will tell your pharmacy that you’re using this payment option. It will only apply to covered Medicare Part D drugs that are processed after your election is confirmed.
When you go to the pharmacy:
When you fill a prescription for an eligible drug, you will pay $0 at the pharmacy. You will still be responsible for your cost share of the drug associated with your Medicare Part D benefit under your plan.
When and How Do I Make Payments?
You will receive a monthly invoice showing the amount you owe, when it’s due and information on how to make a payment.
Your payments may change every month because your monthly bill is 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.
You’ll never pay more than the total amount you would have paid out of pocket or the total annual out-of-pocket maximum.
Missed Payments:
If you miss a payment, you will receive a reminder notice. If you don’t pay your bill by the date listed, you will be removed from this payment option. However, you are required to pay the amount you owe, and you may not be able to join back into this payment option.
Leaving the Program:
You can leave the program at any time, and it will not affect your benefits or coverage. To leave the program go to www.express-scripts.com/mppp. Select the opt-out option. You can also call 1-866-845-1803. After you leave the program, you will get an invoice each month for the amount you owe until your balance is paid.
After you leave this payment option, you will pay the pharmacy directly for new out-of-pocket drug costs.
What Happens If I No Longer Have CareSource Dual Advantage?
If you disenroll from our plan for any reason or you enroll in a new plan with drug coverage, your participation in this payment option will end. You will continue to receive a monthly invoice for the amount owed until your balance is paid in full. If you enroll in a new plan with drug coverage, you may be able to rejoin the Medicare Prescription Payment Plan by contacting your new plan.
Questions?
If you have questions or need help, call Express Scripts at 1-866-845-1803, 24 hours a day, 7 days a week. TTY users can call 1-800-716-3231. If you have a concern, you have the right to follow the grievance process found in your Evidence of Coverage.
Participation in this payment option will automatically make you eligible for important relevant emails.
Express Scripts is administering this program on behalf of CareSource. Express Scripts is working with a third-party supplier to offer the Medicare Prescription Payment Plan. This includes your options to view your account online, schedule and make payments and review your payment history.