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The Medicare Prescription Payment Program (MEDICARE PRESCRIPTION PAYMENT PLAN ) is free to join and does not charge any fees or interest, and no credit check is required to enroll in the program.

Upon acceptance into the Medicare Prescription Payment Program, we will inform your pharmacy that you are using this payment option.

This payment option applies only to Medicare Part D covered drugs processed after your election is confirmed.

When you fill a prescription for an eligible drug, you will pay zero dollars at the pharmacy. However, you will still be responsible for your cost share of the drug associated with your Medicare Part D benefit under your plan that can be paid through a monthly invoice.  The program does not lower the amount of cost-sharing you owe for your Part D prescriptions.

Each month, you will receive an invoice detailing the amount you owe, the due date, and information on how to make a payment. Monthly payments are required while you carry a balance, but you can pay the balance in full at any time.  It is important to pay your bill monthly. Your participation in the Medicare Prescription Payment Plan will be terminated if you fail to pay your monthly billed amount before the end of the grace period.  

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 (previoulsy incurred costs and new out-of-pocket costs), as well as the number of months remaining in the plan year and the amount outstanding. 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.

If you miss a payment, you will receive a reminder notice. If you do not pay your bill by the date listed in the reminder notice, you will be removed from the Medicare Prescription Payment Program. However, you will still be required to pay the amount you owe and may not be able to re-enroll in The Medicare Prescription Payment Program.

You can leave The Medicare Prescription Payment Program at any time by calling the phone number listed on the back of your member ID card. If you opt out, you will still be responsible for paying any remaining balance.  After you opt out, you will continue to receive an invoice each month for the amount you owe until your balance is paid in full.

If you provide an email, participation in this program will automatically make you eligible for important emails containing information related to The Medicare Prescription Payment Program.

If you are disenrolled from your plan for any reason or enroll in a new plan with drug coverage, your participation in The Medicare Prescription Payment Program will end. However, you will continue to receive an invoice each month for any outstanding amounts until your balance is paid in full. You remain responsible for the amount due under this Medicare Prescription Payment Program. If you enroll in a new plan with drug coverage, you may be able to rejoin The Medicare Prescription Payment Program by contacting your new plan.

Any contact information or communication preferences you provide during election or directly through your Medicare Prescription Payment Plan will only be used for your Medicare Prescription Payment Plan Program and may not be communicated to your Medicare Part D plan.  Please ensure you notify your Plan Sponsor as well.

By providing us with your contact information, you consent to our contacting you by any means you have provided regarding important information about your Medicare Prescription Payment Program account. This consent allows us to use text messaging for informational and account service calls, but not for telemarketing or sales calls. This may also include contact from companies working on our behalf to service your account.

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If you’re completing this form for someone else, complete the section below. Your signature certifies that you are authorized under State law to fill out this participation form and have documentation of this authority available if Medicare asks for it.

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When submitted, all information will be removed from the form and

you will receive a confirmation email.

Your confirmation # will be your zipcode-member id-pin code