What is the Medicare Prescription Payment Plan?

The Medicare Prescription Payment Plan is a new payment option that works with your client’s current prescription drug coverage to help them manage their out-of-pocket Part D drug costs by spreading the costs across the calendar year (January–December) instead of paying the full at the pharmacy or through mail order. It can help your clients manage their monthly expenses, but it doesn’t save your clients money or lower their total drug costs.

Starting in 2025, any of your clients with Medicare prescription drug coverage can use this payment option to pay for covered Part D drugs. All AmeriHealth MAPD plans offer this payment option. Participation is voluntary, and there is no cost to participate. There are no fees or interest charged under the program.

How it works

Your client’s must first opt into the program. When they fill a prescription for a covered Part D drug, they won’t pay their pharmacy (including mail order and specialty pharmacies). Instead, they will get a bill each month from AmeriHealth Medicare.

Even though they won’t pay for their drugs at the pharmacy or when receiving their mail order delivery, they are still responsible for the costs. If they want to know what their drug will cost before they take it home, they can call the number on the back of their AmeriHealth ID Card or ask the pharmacist.

How to opt in to the program

Your client must opt in to take advantage of the program, which you will be able to do beginning October 15, 2024.It is your responsibility as their agent to advise them of the program and CMS defines anyone who “likely to benefit” as paying $600 or more in prescription drug costs a year.

Phone

You can call our Member Help Team.

• 65 HMO: 1-800-645-3965 (TTY/TDD: 711), seven days a week from 8 a.m. to 8 p.m.
• Personal Choice 65SM PPO: 1-888-718-3333 (TTY/TDD: 711), seven days a week from 8 a.m. to 8 p.m.
• AmeriHealth 65 PPO: 1-866-569-5190 (TTY/TDD: 711), 8 a.m. to 8 p.m., seven days a week.

Online

• AmeriHealth: The Medicare Prescription Payment Plan website

By mail: AmeriHealth

Download our paper form and mail it to:

AmeriHealth Medicare PPO
1901 Market Street
Philadelphia, PA 19103

By fax: AmeriHealth

Download our paper form and fax it to 1-215-761-0300.

Member Materials, Communications, and Outreach

• AmeriHealth Medicare newly enrolled or members who change plans during the Annual Enrollment Period will receive a paper copy of the form within their 2025 Welcome Kit.
• Any current AmeriHealth member who meets the CMS defined “likely to benefit” $600 amount will receive communications from their health plan to educate them on the payment plan and provide options on how to enroll into the payment plan.
• During November, AmeriHealth Member Help Team representatives will make outbound calls to member. During our attempt to outreach, members who are likely to benefit will be notified of the payment plan and ways to enroll into the payment plan. They will be provided the option to enroll with the Member Help Team representative over the phone during that same phone call.
• Resources and more information about the IRA are available online at or amerihealthmedicare.com/ira.