Medicare Prescription Payment Plan

The Medicare Prescription Payment Plan is a new option 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 coverage can use this payment option. All plans offer this payment option and participation is voluntary.

Medicare Prescription Payment Plan Fact Sheet 

Is the Medicare Prescription Payment Plan right for me?

This payment option might help you manage your monthly expenses, but it doesn’t save you money or lower your drug costs. Use this helpful online tool from Medicare to see if the Medicare Prescription Payment Plan is right for you: Will this payment option help me?

The Medicare Prescription Payment Plan 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.

Note that if you switch Medicare plans, you will no longer be enrolled in the Prescription Payment Plan and will have to sign up again. This includes plan changes within BCBSRI or with another insurer. 

How to sign up

You must be enrolled in a plan that includes Part D prescription drug coverage.

Online

Log in to your online member account at myBCBSRI.com and use the "Go to myPrime" link under Pharmacy Tools.

Phone

833-696-2087 (TTY: 711)
October 1 – March 31, call us 7 days a week, 8:00 a.m. to 1:00 a.m. (Eastern)
April 1 – September 30, call us Monday through Friday, 8:00 a.m. to 11:00 p.m. (Eastern)

Mail

Blue Cross & Blue Shield of Rhode Island
Mailstop: 1001
MPPP Election Dept.
13900 N. Harvey Ave
Edmond, OK 73013

Processing time

During the Annual Enrollment Period (before January 1, 2025): Once your completed enrollment request is received, we must process the request within 10 calendar days of receipt, or the number of calendar days before the plan enrollment starts, whichever is shorter. 

After January 1, 2025: When a request is received during the plan year, we must process it within 24 hours of receipt. 

If you believe that any delay in filling the prescription(s) due to the 24-hour timeframe required to process the request to opt in may seriously jeopardize your life, health, or ability to regain maximum function you may ask the pharmacy to submit the claim under the Medicare Prescription Payment Plan; you must then request a retroactive election within 72 hours of the date and time the urgent claim(s) were adjudicated. Once the enrollee’s Medicare Prescription Payment Plan election has been effectuated, the Part D sponsor must process the reimbursement for all cost sharing paid by the enrollee for the urgent prescription and any covered Part D prescription filled between the date of adjudication of the urgent claim and the date that the enrollee’s election is effectuated within 45 calendar days of the election date. If we determine that you failed to request a retroactive election within the required timeframe, we must promptly notify you of our determination and provide instructions on how you may file a grievance.

How to leave the Medicare Prescription Drug Program

You can leave the Medicare Prescription Payment Plan at any time by:

Online

Opting out via the Payment Portal in your online member account. This option will be available starting January 1, 2025.

Phone

833-696-2087 (TTY: 711)
October 1 – March 31, call us 7 days a week, 8:00 a.m. to 1:00 a.m. (Eastern)
April 1 – September 30, call us Monday through Friday, 8:00 a.m. to 11:00 p.m. (Eastern)

• Leaving won’t affect your Medicare drug coverage and other Medicare benefits.
• 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.

Are all my prescription drugs included in the program?

All Medicare Part D covered prescription drugs are included in the Medicare Prescription Payment Plan. Medicare Part B drugs are not eligible to be included in the program.

File complaints and grievances related to the program 

A “grievance” is any type of complaint you make about your Medicare Advantage Plan or one of our network providers or network pharmacies. A grievance can also include a complaint you may have about the quality of care you receive. An “appeal” is a special kind of complaint you make if you disagree with a decision (determination) made by the Plan. You can find more information including how to file a grievance or appeal here: Grievance and appeals facts.

What programs might help lower my drug costs?

The Medicare Prescription Payment Plan might help you manage your monthly expenses, but it doesn’t save you money or lower your drug costs. You may qualify for one of the following programs to help reduce your prescription drug costs:

Extra Help

A Medicare program that helps you pay your drug costs if you have limited income and resources. The Part D Low-Income Subsidy (LIS) program has recently expanded to cover more drug costs for people with limited resources.

LIS enrollment, for those who qualify, is likely more advantageous than participation in the Medicare Prescription Payment Plan.

See if you qualify for Extra Help by calling:

• 1-800-Medicare (TTY users should call1-877-486-2048) 24 hours a day, 7 days a week
• Your State Medicaid Office
• Social Security Administration, 1-800-772-1213 (TTY users should call 1-800- 325-0778), 7:00 a.m. to 7:00 p.m., Monday through Friday

Medicare Savings Program

A state-run program that helps people with limited income and resources pay some or all their Medicare premiums, deductibles, and coinsurance. Visit medicare.gov/medicare-savings-programs to learn more.

State Pharmaceutical Assistance Program (SPAP)

A program that may 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 go.medicare.gov/spap to learn more.

Manufacturer’s Pharmaceutical Assistance Programs

Sometimes called Patient Assistance Programs (PAPs). A program from drug manufacturers to help lower drug costs for people with Medicare. Visit go.medicare.gov/pap to learn more.