Medicare Prescription Payment Plan

Frequently Asked Questions

Will Medicare Prescription Plan save members money?

No. The program will not save you money or lower your drug costs. It will simply spread the cost of your medications over the remaining months of the plan year.

Will this plan help me?

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. There are other programs available that can help you save money on prescription drugs.

CMS defines a member as "likely to benefit" as:

• Members who reach their $2,100 out-of-pocket maximum within the first nine months of the plan year
• Members who have a single prescription with an out-of-pocket cost greater than $600

Although these are the ways CMS defines a member as "likely to benefit" the impact of the payment plan on each individual depends on their own personal situation. You will want to consider beyond these definitions to decide if the program is right for you.

The Medication Prescription Payment Plan might not be right for you if:

• You already qualify for Extra Help
• You who qualify for a Medicare Savings Program
• You who qualify for the Low-Income Subsidy Program (LIS)
• You who get help paying for their drugs from other organizations, like State Pharmaceutical Assistance Programs (SPAPs)
• You who have low yearly drug costs
• You who have drug costs that are the same each month
• You who are signing up late in the plan year (after September)

What programs can help lower my costs? If you have limited income and resources, find out if you’re eligible for one of these programs:

• Extra Help: A Medicare program that helps pay your Medicare drug costs. Visit ssa.gov/medicare/part-d-extra-help to find out if you qualify and apply. You can also apply with your State Medical Assistance (Medicaid) office.
• Medicare Savings Programs: State-run programs that might help pay some or all of your Medicare premiums, deductibles, copayments, and coinsurance. Visit Medicare.gov/medicare-savings-programs to learn more.
• State Pharmaceutical Assistance Programs (SPAPs): 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.
• Manufacturer Pharmaceutical Assistance Programs (sometimes called Patient Assistance Programs (PAPs)): Programs from drug manufacturers to help lower drugs costs for people with Medicare. Visit go.medicare.gov/pap to learn more. Many people qualify for savings and don’t realize it. Visit Medicare.gov/basics/costs/ help, or contact your local Social Security office to learn more. Find your local Social Security office.

If a member qualifies for special programs those will be more advantageous to the member than participation in the Medicare Prescription Payment Plan.

Who is administering the program for Wellmark Advantage Health Plan^® ?

CVS Caremark^® is administering the Medicare Prescription Payment Plan on behalf of Wellmark Advantage Health Plan.

How am I billed and how is a monthly bill calculated?

If you opt in to the program, they will pay your monthly Wellmark Advantage Health Plan premium (if you have one), then you'll receive a separate bill from CVS/Wellmark Advantage Health Plan for your prescription drugs instead of paying the pharmacy directly. Payment method options will be provided with the invoice.

All plans use the same formula to calculate monthly payments. Monthly bills will be based on what you owe for any prescriptions you're getting, plus the previous month’s balance, divided by the number of months left in the plan year. The program is free to join and there are no fees or interest charged under the program. Please see the CMS Fact Sheet for further details on how the program invoices are calculated.

Key points to remember:

• A payment will likely be different each month based on out-of-pocket costs, so you may not know what your exact bill will be ahead of time.
• Future payments will likely increase when you fill a new prescription or refill existing prescriptions, as out-of-pocket costs increase and the number of months remaining in the year will be fewer.
• An invoice/bill can be paid through a bank ACH payment, by using a debit or credit card, or by sending a check to the address listed on the invoice.
• Monthly invoices will begin in Feb. 2026 for enrolled participants with an effective date of Jan. 1, 2026.
• For each billing period, the Part D sponsor will calculate the monthly invoice amount, considering out-of-pocket costs incurred that month on or after your opt-in date.
• The monthly invoice informs you of Part D costs applied to the payment plan, along with the specific amount due and a deadline for payment.

How do I pay my monthly Medicare Prescription Payment Plan Bill?

1. Online via your member portal with credit, debit or bank account.
   • Go to WellmarkAdvantageHealthPlan.com/login to create an account or log in.
   • Once in the portal, click CVS Pharmacy on the right-hand side.
   • You will be asked to sign up for the CVS portal if you have not done so already.
   • Select “Benefits and claims” and select “Medicare Prescription Payment Plan”.
2. Through the mail with a check.
   • Please include the tear-off portion of your bill with your check.
   • Write your Member ID on the check. Mail the check to the address listed on your bill.
3. By phone. CVS customer service can assist with payments over the phone. TTY users can call 711, 24 hours a day, seven days a week.
   • PPO: 1-888-832-6168 (TTY: 711)

What happens if I don’t pay my monthly bill?

If you fail to pay the monthly billed amount, they will be disenrolled from the payment program and billed until their balance is paid in full. CVS/Wellmark Advantage Health Plan will send the terminated member the following communications:

• Prior to disenrollment: A notice of failure to pay within 15 calendar days of the payment due date
• Following disenrollment: A termination notice after the member has failed to pay the amount due by the end of the grace period (i.e., two months)

If a member feels an error was made regarding their Medicare Prescription Payment Plan bill, they can call the number on the back of their Wellmark member ID card. If members feel an error was made, they have the right to follow the grievance process found in the Member Handbook or Evidence of Coverage.

How do I opt-out?

If you enroll in the program and later decide you would like to opt-out, you must notify CVS directly by phone or via the CVS Medicare Prescription Payment Plan member portal. CVS/Wellmark Advantage Health Plan will send you a notice of termination. Once the termination is processed, the Part D sponsor must maintain appropriate records of the termination.

After you opt out of the program, CVS/Wellmark Advantage Health Plan will continue to bill you until your Medicare Prescription Payment Plan balance is paid in full. You can repay the full outstanding amount in a lump sum, but CVS/Wellmark Advantage Health Plan will not require a full immediate repayment.

After opting out, you will pay any new out-of-pocket costs directly to the pharmacy.

Can a terminated member be reinstated in the program?

CVS/Wellmark Advantage Health Plan will reinstate a member in the program if that member demonstrates a good cause for failure to pay the monthly amount billed within the grace period and pays any past due balance in full.

How and when am I notified I am active in the program?

If you sign up for the Medicare Prescription Payment Plan during AEP, the Part D sponsor must process the request within 10 calendar days. If you sign up during the plan year, the Part D sponsor must process the request within 24 hours and communicate an approval, request for additional information, or denial. The Part D sponsor then must deliver a written notice within three calendar days of delivering the initial telephone notice. If you have fulfilled all program election requirements, but the Part D sponsor is unable to process the election into the program in the required amount of time due to no fault of you, the Part D sponsor must process a retroactive election back to the original date when you should have been admitted into the Medicare Prescription Payment Plan (i.e., within 24 hours of providing the requisite information for election into the program). In addition, the Part D sponsor must reimburse you for any out-of-pocket cost sharing paid on or after that date and include those amounts, as appropriate, in a monthly bill under the program within 45 days.

How do I enroll?

You will have the option to sign up in the program during the Annual Enrollment Period (AEP) from, Oct. 15 - Dec. 7. You can also sign up during the plan year at any time. If you sign up during 20245, the payment plan will not take effect until Jan. 1, 2026.

Select one of the following options to sign up:

• Mail a completed Medicare Prescription Payment Plan Participation Request Form (PDF) to the address on the form.
  • Wellmark PPO
• Visit the member portal. You’ll be taken to an external site where your information will be encrypted and securely sent.
• Call a CVS customer service representative.
  • Wellmark PPO: 1-888-832-6168 (TTY: 711)

How do I file a grievance or complaint?

If you need to file a complaint or grievance, you have the right to follow the grievance process found in the Member Handbook or Evidence of Coverage.