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 will get a bill each month from MVP. 

Even though you won’t pay for your drugs at the pharmacy, you are 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 the MVP Medicare Prescription Payment Plan help line at 1-844-889-9792 (TTY 711).

Your monthly bill is based on what you would have paid for any prescriptions you get, plus your previous month’s outstanding balance, divided by the number of months left in the year. 

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. 

In a single calendar year (January–December), you will never pay more than:

• The total amount you would have paid out of pocket to the pharmacy if you weren’t participating in this payment option
• The Medicare drug coverage annual out-of-pocket maximum ($2,000 in 2025)

The prescription drug law caps your out-of-pocket drug costs at $2,000 in 2025. This is true for everyone with Medicare drug coverage, even if you don’t participate in the Medicare Prescription Payment Plan.

It depends on your situation. Remember, this payment option might help you manage your monthly expenses, but it doesn’t save you money or lower your drug costs.

You’re most likely to benefit from participating in the Medicare Prescription Payment Plan 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. Visit Medicare.gov to answer a few questions and find out if you’re likely to benefit from this payment option.

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 are 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

• MVP: Call us at 1-844-889-9792 (TTY 711). Call MVP if you have an urgent need to pick up a prescription.
• Medicare: Visit Medicare.gov to learn more about this payment option and if it might be a good fit for you
• State Health Insurance Assistance Program (SHIP): Visit shiphelp.org to get the phone number for your local SHIP and get free, personalized health insurance counseling

To elect to participate in this program, you can: 

• Sign in to Gia® online and select Payments and Claims, and then Prescription Payment Plan
• Call us at 1-844-889-9792 (TTY 711)
• Mail the Medicare Prescription Payment Plan Participation Election Request Form (PDF) or Solicitud de Participación Plan de Pago de Medicamentos con Receta de Medicare (PDF) to the address on the form

You can enroll in 2024 before your plan starts for an effective date of January 1, 2025. You can also enroll at any time during 2025.

Once your participation request is approved, you will receive both an automated confirmation phone call and a written notice from MVP confirming your participation in the Medicare Prescription Payment Plan. 

1. When you get a prescription for a drug covered by Part D, your plan will automatically let the pharmacy know that you’re participating in this payment option, and you won’t pay the pharmacy for any prescriptions, including those with a low cost.

   Note: Even though you won’t pay for your drugs at the pharmacy, you are still responsible for the costs. If you want to know what your drug will cost before you take it home, call MVP at 1-844-889-9792 (TTY 711) or ask the pharmacist.

2. Each month, MVP will send you a bill with the amount you owe for your prescriptions, when it’s due, and information on how to make a payment. You’ll get a separate bill for your monthly plan premium (if you have one).

Once you receive a bill, sign in to Gia®  online and select Payments and Claims, then Prescription Payment Plan, or mail a check to the address on the invoice. See your invoice for additional payment options.

MVP will send a reminder if you miss a payment. If you don’t pay your bill by the date listed in that reminder, you will be removed from the Medicare Prescription Payment Plan. You are 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 are removed from the Medicare Prescription Payment Plan, you will 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 think there is a mistake on your Medicare Prescription Payment Plan bill, call the number on your invoice. You also have the right to follow the grievance process found in your Evidence of Coverage (EOC), as appropriate. As a member you should have received an EOC. You can also access your EOC online by signing in to Gia online and selecting My Plan, then My Benefits, then Download Member Guide.

You can leave the Medicare Prescription Payment Plan at any time by signing in to Gia online and selecting Payments and Claims, and then Prescription Payment Plan. You can also opt-out by calling 1-844-889-9792 (TTY 711). Leaving won’t affect your Medicare drug coverage and other Medicare benefits. Keep in mind:

• If you still owe a balance, you are required to pay the amount you owe, even though you are no longer participating in this payment option
• You will 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 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.