Medicare Prescription Payment Plan

Program overview

The Medicare Prescription Payment Plan is a new payment 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 plan or Medicare health plan with drug coverage (like a Medicare Advantage Plan with drug coverage) can use this payment option. All plans offer this payment option and participation is voluntary.

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 bill from your health or drug plan to pay for your prescription drugs (instead of paying the pharmacy). There’s no cost to participate in the Medicare Prescription Payment Plan.

See the Medicare Fact Sheet for complete details and frequently asked questions about the Medicare Prescription Payment Plan, including:

• How it works.
• Who would benefit or not benefit from this program.
• Examples of how monthly bills are calculated.
• What happens if you don’t pay your Medicare Prescription Payment Plan bill.
• Other programs that can help lower costs.

Additional information about the program

• How to sign up for the Medicare Prescription Payment Plan
• What happens if you don’t pay your Medicare Prescription Payment Plan bill
• How to leave the Medicare Prescription Payment Plan
• Retroactive election into the Medicare Prescription Payment Plan
• How to file a complaint or grievance
• Contact us for more information

How to sign up for the Medicare Prescription Payment Plan

You can sign up for the Medicare Prescription Payment Plan any of the below ways. The payment plan option does not take effect until Jan. 1, 2025. To spread your costs over as many months as possible, we do not recommend enrolling into the payment plan later in the calendar year (after September).

• Apply online
• Print and mail in an election form
• Call: 1-866-845-1803 (TTY: 1-800-716-3231), 24 hours a day, 7 days a week

If you are a current UPMC for Life member and you opt into the payment plan during the calendar year, your election request will be processed within 24 hours.  

If you are a new member and you opt in before your plan’s effective date, your election request will be processed before your plan effective date or within 10 days, depending on when you submit your request. 

What happens if you don’t pay your Medicare Prescription Payment Plan bill

Like any other debt, you must pay the amount you owe by the due date provided to you. If you do not make your monthly payments, you will be disenrolled from the Medicare Prescription Plan, and you’ll pay the pharmacy directly for all your out-of-pocket drug costs.

Your Medicare drug coverage and other Medicare benefits won’t be affected, and you’ll continue to be enrolled in UPMC for Life for your drug coverage.

How to leave the Medicare Prescription Payment Plan

You can leave the Medicare Prescription Payment Plan at any time by contacting Express Scripts at 1-866-845-1803 (TTY: 1-800-716-3231), 24 hours a day, 7 days a week. 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.

Retroactive election into the Medicare Prescription Payment Plan 

Suppose you have urgent prescriptions that need to be filled prior to the 24-hour time frame to process your request for enrollment into the Medicare Prescription Payment Plan. In that case, you can get retroactive coverage if you meet the following criteria:

• Your health would’ve been jeopardized if your prescriptions were not filled sooner than the 24-hour time frame required to process your request.
• You must submit your request for retroactive election within 72 hours of the date and time the urgent claims were determined.

Once your Medicare Prescription Payment election is processed, you will be reimbursed for all cost sharing paid for the urgent prescription and any covered Part D prescription filled between the date of that fill and the date that your election was processed within 45 days of the election date. If your request is denied, you will be notified and can file a complaint or grievance.

How to file a complaint or grievance

You can submit a complaint or grievance related to this program in any of the following ways:

• Call your Health Care Concierge team at the phone number on your member ID card.
• Fax to: 412-454-7920
• Write to:
  UPMC for Life
  Attn: Appeals and Grievances
  PO Box 2939
  Pittsburgh, PA 15230-2939
• Submit a grievance to Medicare
  • Go to medicare.gov complaint form.
  • Or call 1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.

Contact us for more information

For questions about the program, call 1-866-845-1803 (TTY: 1-800-716-3231) 24 hours a day, 7 days a week.