Medicare Prescription Payment Plan

You’re most likely to benefit 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. 

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.

Log in to your PBDRx account to opt in to the payment program. Once you are logged in, look for the 'Prescription Payment' information on the homepage.

Don't have an account yet? Visit my.pbdrx.com/register or contact Member Services to get started.

You’ll get a reminder if you miss a payment. If you don’t pay your bill by the due date, you may 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 Advantage plan. Please Note: Always pay your monthly premium first (if you have one), so you don’t lose your drug coverage. 

Pharmacy Benefit Dimensions has a process to effectuate a retroactive election into the Medicare Prescription Payment Plan when a member has certain urgent prescription fill(s) for which they paid the associated cost sharing before their program election was received and processed. 

Under this policy, a retroactive election must be processed if all the following conditions are met:

• The member believes that any delay in filling the prescription(s) due to the 24 hours timeframe required to process their request to opt in in may seriously jeopardize their life, health, or ability to regain maximum function; and
• The member requests retroactive election within 72 hours of the date and time the urgent claim(s) were adjudicated.

Once the member’s Medicare Prescription Payment Plan election has been effectuated, Pharmacy Benefit Dimensions must process the reimbursement for all cost sharing paid by the member for the urgent prescription and any covered Part D prescription filled between the date of adjudication of the urgent claim and the date that the enrollee’s election is effectuated within 45 calendar days of the election date. 

If Pharmacy Benefit Dimensions determines that a member failed to request retroactive election within the required timeframe, we will promptly notify the member of the determination and provide instructions on how the member may file a grievance.

Opting out: You can leave the Medicare Prescription Payment Plan at any time by contacting Member Services. Leaving won’t affect your Medicare drug coverage.  

Please Note:

• 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.
• Every year, your plan will automatically renew your participation in this payment option, unless you change plans or contact your plan to opt out.

To file a complaint or grievance related to this program, please contact Member Services or find more information here.

If you have limited income and resources, you may be eligible for Extra Help or Low Income Subsidy (LIS). LIS is a Medicare program that helps pay your Medicare drug costs. 

More Information:

• Visit to find out if you qualify and apply: ssa.gov/medicare/part-d-extra-help  
• Call: You can also apply with your State Medical Assistance (Medicaid) office. 
• To learn more, visit: Medicare.gov/ExtraHelp

The Centers for Medicare and Medicaid Services has developed a fact sheet that includes information on how to calculate your payments depending on your costs.  Read more