What is Medicare Prescription Payment Plan (M3P)?
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 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 us to pay for your prescription drugs (instead of paying the pharmacy). There’s no cost to participate in the Medicare Prescription Payment Plan, and you won’t pay any interest or fees on the amount you owe, even if your payment is late.
Who is likely to benefit?
You’re most likely to benefit from participating in the Medicare Prescription Payment Plan if you have high out-of-pocket drug costs earlier in the calendar year. This payment option spreads out what you’ll pay each month across the calendar year (Jan – Dec), so you don’t have to pay out-of-pocket costs to the pharmacy. This payment option might help you manage your monthly expenses, but it doesn’t save you money or lower your drug costs.
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
Medicare has a website where you can answer a few questions to find out if you are likely to benefit from the Medicare Prescription Payment Plan.
How do you opt in or out of the program?
You can sign up for this plan by calling and informing us that you want to start participating in this payment option. You may also download the Election Request Form (coming soon) and complete the form and mail it back to us to signup for the plan. You can also opt into or opt out of the program by logging into your Member Portal. Click on the section for Pharmacy Benefits to be routed to our PBM’s member portal and you will see a section in the portal for Medicare Prescription Payment Plan (M3P).
- In 2024, for 2025: If you want to participate in the Medicare Prescription Payment Plan for 2025, contact your plan now. Your participation will start January 1, 2025.
- During 2025: Starting January 1, 2025, you can contact your plan to start participating in the Medicare Prescription Payment Plan anytime during the calendar year.
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.
You can leave the Medicare Prescription Payment Plan at any time by contacting your
health or drug plan. 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 if I have to fill an urgent prescription but my election has not been processed, yet?
If you believe that any delay in filling your prescription(s) (due to the 24 hours timeframe required to process your M3P request to opt in) may seriously jeopardize your life, health, or ability to regain maximum function; and
You request retroactive election within 72 hours of the date and time the urgent claim(s) were adjudicated,
We will reimburse you for the cost of the urgent prescription and any covered Part D prescription filled between the date of processing of the urgent claim and the date that your election is effectuated within 45 calendar days of the election date.
We will notify you if your request was made outside of the allowed timeframe of 72 hours and will provide you with more information, such as the right to file a grievance.
How will my costs work?
The prescription drug law caps your out-of-pocket Part D drug costs at $2,000 in 2025. This means you’ll never pay more than $2,000 in out-of-pocket Part D drug costs in 2025. This is true for everyone with Medicare drug coverage, even if you don’t join the Medicare Prescription Payment Plan.
When you fill a prescription for a drug covered by Part D, you won’t pay your pharmacy (including mail order and specialty pharmacies). Instead, you’ll get a bill from us each month. Your monthly bill is based on what you would have paid for your prescriptions, plus your previous month’s balance, divided by the number of months left in the year. 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, ask the pharmacist or call us and talk to our Capital Rx Customer Service team at (888) 227-7940.
Note: 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 drug costs get added to your monthly payment, there are fewer months left in the year to spread out your remaining payments.
For more information on how your monthly payments are calculated, see examples attached (coming soon). You may also see additional information at our Pharmacy FAQ page.
Importance of paying your monthly bills
After we approve your participation in the Medicare Prescription Payment Plan (M3P), you’ll get a letter from us with information about how to pay your bill. If you miss a payment, we will remind you to make your 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 and go back to paying your pharmacy directly. You’ll still be 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 Memorial Hermann Advantage plan. Always pay your health plan monthly premium first (if you have one), so you don’t lose your health plan coverage.
How to file a grievance for M3P?
Call us if you think we made a mistake about your Medicare Prescription Payment Plan bill. If you think we made a mistake, you have the right to file a complaint (sometimes called a “grievance”). For more information about the grievance process, please visit our grievance page or see Chapter 9 in your Evidence of Coverage (EOC) document for how to file a complaint.
What if I still can’t afford my prescriptions?
If you have limited income and resources, you may qualify for savings and not realize it. Visit Medicare.gov/basics/costs/help or contact your local Social Security office to learn more about the recent LIS expansion of eligibility, and how to apply and enroll in the LIS program. Find your local Social Security office at ssa.gov/locator/. You may also learn more about Extra Help programs and other ways to save money by going to our Medicare Extra Help and Low Income Subsidy (LIS) page.
Where can I find additional information?
To learn more about the Medicare Prescription Payment Plan (M3P), to opt in to participate or to opt out to remove yourself from the payment plan, or if you would like general information about payments, future payments or other general information, please call Pharmacy Customer Service at (888) 227-7940, 24 hours a day/7 days a week/365 days a year. You may also log into your member portal to view detailed information about your payment plan, your invoices, opt in or out of the program and to make payments.
Medicare has also provided a website, a summary sheet, and a detailed Fact Sheet with additional information about the Medicare Prescription Payment Plan.
For more information, please call the Pharmacy Customer Service at (888) 227-7940, 24 hours a day/7 days a week/365 days a year.