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 each month from Peak Health Medicare Plans.

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 our plan or ask the pharmacy.

This payment option might help you manage your monthly expenses, but it doesn’t save you money or lower your drug costs.  

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. There are no additional fees or interest charges for participating in this payment plan.

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

Peak Health Medicare Plans: If you are a current plan member, call our plan to get more information. If you need to pick up a prescription urgently, call our plan to discuss your options.

Medicare: Visit Medicare.gov/prescription-payment-plan to learn more about this payment option and if it might be a good fit for you.

If you believe that any delay in filling your prescription(s) due to the 24 hour timeframe required to process your request 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 your pharmacy billed your medications, our plan will reimburse you for all cost share for the urgent prescription(s), and you will pay your out-of-pocket Part D drug costs through the payment plan.

Once Peak Health Medicare Plans reviews your participation request, we will send you a letter confirming your participation in the Medicare Prescription Payment Plan and information about how to pay your bill. Then:

After our plan approves your participation in the Medicare Prescription Payment Plan, you’ll get a letter from us with information about how to pay your bill.

You’ll get a reminder from our 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 prescription drug costs.

Call our plan 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 follow the grievance process found in your Evidence of Coverage.

You can leave the Medicare Prescription Payment Plan at any time by contacting our health plan. We will send you a notification confirming you have opted out of the payment program. Leaving will not 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.

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.

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.

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.

Programs from drug manufacturers to help lower drugs costs for people with Medicare. Visit go.medicare.gov/pap to learn more.

Medicare provides “Extra Help” to pay prescription drug costs for people who have limited income and resources. Resources include your savings and stocks, but not your home or car. If you qualify, you get help paying for any Medicare drug plan’s monthly premium, yearly deductible, and prescription copayments. This “Extra Help” also counts toward your out-of-pocket costs.

On January 1, 2024, the Inflation Reduction Act (IRA) expanded eligibility for individuals with incomes up to 150% of the federal poverty level and who meet certain resource requirements full benefits under the Low-Income Subsidy program (LIS or “Extra Help”) under Medicare Part D.

The Extra Help program, for those who qualify, is likely more advantageous than participation in the Medicare Prescription Payment Plan.

If you automatically qualify for “Extra Help” Medicare will mail you a letter. You will not have to apply.

If you do not automatically qualify you may be able to get “Extra Help” to pay for your prescription drug premiums and costs.

If you have a problem or complaint regarding the Medicare Prescription Payment Plan, please call Navitus Customer Care at 1-855-847-1026. Calls to this number are free and available 24 hours a day, 7 days a week (excluding Thanksgiving and Christmas Day).

For more information on filing a complaint or grievance, see your Evidence of Coverage.