Medicare Prescription Payment Plan
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 costs for drugs covered by your Part D plan by spreading them across the calendar year (January-December). Anyone with a Medicare drug plan or Medicare health plan with drug coverage (like a Medicare Advantage Plan with drug coverage) can use this payment option. PacificSource Medicare offers this payment option and participation is voluntary, and there's no cost to participate.
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 separate bill from us to pay for your prescription drugs (instead of paying the pharmacy).
What to know before participating
How does it work?
When you fill a prescription for a covered Part D drug, you won't pay your pharmacy (including mail order and specialty pharmacies). Instead, you'll get a bill each month from your health plan.
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.
This payment option might help you manage your monthly expenses, but it doesn't save you money or lower your drug costs.
How is my monthly bill calculated?
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. All plans use the same formula to calculate your monthly payments. See examples below.
Your payments might change every month, so 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 costs get added to your monthly payment, there are fewer months left in the year to spread out your remaining payments.
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 out-of-pocket maximum for prescription drugs covered by your plan ($2,100 in 2026).
The prescription drug law caps your out-of-pocket costs for covered drugs at $2,100 in 2026. This is true for everyone with Medicare drug coverage, even if you don't participate in the Medicare Prescription Payment Plan.
Will this help me?
It depends on your situation. Remember, this payment option might help you manage your monthly expenses, but it doesn't save you money or lower your drug costs. You're most likely to 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 in the year (like before September), gives you more months to spread out your drug costs. 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.
If there's a drug that you'd like to take but it's too expensive, and you think this payment option might spread out the cost enough to work for you, contact your plan to confirm the drug is covered and get more help.
This payment option may not be the best choice for you if:- 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.
- 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), a coupon program, or other health coverage.
See below to learn about programs that can help lower your costs.
Who can help me decide if I should participate?
PacificSource Medicare: Call 888-863-3637, TTY 711 and speak to a customer service representative.
Medicare: Visit Medicare.gov/prescription-payment-plan to learn more about this payment option and if it might be a good fit for you.
State Health Insurance Assistance Program (SHIP): Visit shiphelp.org to get the phone number for your local SHIP and get free, personalized health insurance counseling.
How do I sign up?
To start participating in this payment option you can complete the Medicare Prescription Payment Plan election request form, updated 11/19/2025.
Submit your completed form to:-
PacificSource Medicare
Medicare Prescription Payment Plan
PO Box 7
Pittsburgh, PA 15230 - Fax: 833-896-0658
If you have questions or need help completing this form, call us at 866-362-4009, TTY users can call 711, 24 hours a day, 7 days a week, 365 days a year.
Existing PacificSource members can also complete the participation request form online at InTouch.PacificSource.com/Members. Go to "Tools" in the top menu and click on "Caremark Online Rx," Medicare Prescription Plan option.
You can contact us to start participating in the Medicare Prescription Payment Plan anytime during the calendar year. Once you have opted into the program, your election request will be processed within 24 hours and notice of election will be sent to you within 3 calendar days.
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.
What to know if I'm participating
What happens after I sign up?
Once your health or drug plan reviews your request, they'll send you a letter confirming your participation in the Medicare Prescription Payment Plan and information about how to pay your bill. Then:- 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.
- 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).
What happens if I don't pay my bill?
You'll get a reminder from your health or drug plan if you miss a payment. If you don't pay your bill by the date listed in that reminder, you'll be removed from the Medicare Prescription Payment Plan. You're required to pay the amount you owe, but you won't pay any interest or fees, even if your payment is late. You can choose to pay that amount all at once or be billed monthly. If you're removed from the Medicare Prescription Payment Plan, you'll still be enrolled in your Medicare health or drug plan.
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 below for information about programs that can help lower your costs.
Call customer service if you think we have made a mistake about your Medicare Prescription Payment Plan bill. If you think we have made a mistake, you have the right to follow the grievance process found in your Member Handbook or Evidence of Coverage. Contact customer service at 888-863-3637, TTY or email newappeal@pacificsource.com.
How do I leave?
You can leave the Medicare Prescription Payment Plan at any time by calling us at 866-362-4009, TTY users can call 711, 24 hours a day, 7 days a week, 365 days a year, or online via InTouch.PacificSource.com/Members. Under "Tools" in the top menu, click on "Caremark Online Rx," Medicare Prescription Plan option. Leaving won't affect your Medicare drug coverage and other Medicare benefits. 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.
What happens if I change health or drug plans?
If you leave your current plan, or change to a new Medicare drug plan or Medicare health plan with drug coverage (like a Medicare Advantage Plan with drug coverage), your participation in the Medicare Prescription Payment Plan will end.
Contact your new plan if you'd like to participate in the Medicare Prescription Payment Plan again.
What programs can help lower my costs?
If you have limited income and resources, find out if you're eligible for one of these programs:- Extra Help: A Medicare program that helps pay your Medicare drug costs. Visit ssa.gov/medicare/part-d-extra-help to apply and find out if you qualify. You can also apply with your State Medical Assistance (Medicaid) office. Visit Medicare.gov/ExtraHelp to learn more.
- Medicare Savings Programs: State-run programs that might help pay some or all of your Medicare premiums, deductibles, copayments, and coinsurance. Visit Medicare.gov/medicare-savings-programs to learn more.
- State Pharmaceutical Assistance Programs (SPAPs): Programs that might 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 Pharmaceutical Assistance Programs (sometimes called Patient Assistance Programs (PAPs)): Programs from drug manufacturers to help lower drugs costs for people with Medicare. Visit go.medicare.gov/pap to learn more.
Many people qualify for savings and don't realize it. Visit Medicare.gov/basics/costs/help , or contact your local Social Security office to learn more. Find your local Social Security office at ssa.gov/locator/ .
Where can I get more information?
PacificSource Medicare: Call 866-362-4009, TTY users can call 711, 24 hours a day, 7 days a week, 365 days a year or visit caremark.com/mppp .
Medicare: Visit Medicare.gov/prescription-payment-plan , or call 800-MEDICARE (800-633-4227), 24 hours a day, 7 days a week. TTY users can call 877-486-2048.
To learn more, see the CMS Fact Sheet, updated 11/12/2025.