Medicare Prescription Payment Plan

If you opt into the MPPP, you won't pay at the pharmacy when you get a Medicare Part D drug. Highmark Health Options Duals will pay the pharmacy and then send you a bill each month. Bills for other expenses, like your premium, will be sent separately.   

You must pay your bill by the due date provided. You will be disenrolled from the MPPP if you fail to make your monthly payments. You'll keep getting bills until you pay everything you owe. You cannot rejoin the program until you pay off your balance.

Keep in mind, the annual out-of-pocket maximum may vary each year and is $2,100 for 2026.

VIEW FACT SHEET

You may be likely to benefit from the MPPP if the following situations apply to you. Please remember, the MPPP may help you manage your monthly expenses, but it doesn’t save you money or lower your Medicare Part D drug cost.

• You need expensive Medicare Part D drugs early in the year.
• You expect to pay the annual out-of-pocket maximum amount of $2,100 before September 2026.
• You want to pay for your Medicare Part D drug costs monthly throughout the year. 

Answer a few questions and find out if you are likely to benefit from the MPPP. 

USE TOOL

You can opt into the MPPP any time during the year using the following options:

• Online: Sign in or register  
• By phone: 1-833-957-0025 (TTY: 711). Calls to this number are toll free.

October 1-March 31, 8 a.m.- 8 p.m., April 1 – September 30, Monday-Friday, 8 a.m. – I p.m.

• By mail: Print the Medicare Prescription Payment Plan Form, fill it out and mail it to:

Highmark Health Options Duals
Medicare Prescription Payment Plan
P.O. Box 7
Pittsburgh, PA 15230

Highmark will process complete election requests within the following timeframes.

• 10 calendar days of receipt for elections received prior to the plan year.
• 24 hours of receipt for elections received during the plan year.
• Election requests processed outside of 24 hours due to no fault of the enrollee will be retroactively effective and the enrollee will be reimbursed for any cost sharing in appropriately paid within 45 days.

You can retroactively elect to opt into the MPPP when you meet the following criteria:

• You believe that any delay in filling your Medicare Part D drugs, due to the 24-hour time frame required to process your opt in request, may seriously jeopardize your life, health, or ability to regain maximum function.
• You request the retroactive election within 72 hours of the date and time your Medicare Part D drug claim was paid.

If you join the MPPP, you'll stay in it from year to year unless you decide to leave. If you switch to a different plan, you'll need to sign up for the program again.

You can opt out of the MPPP any time during the year using the following options: 

• Online: Sign in or register 
• By phone: 1-844-722-5837 (TTY 711). Calls to this number are toll free.  

October 1-March 31, 8 a.m.- 8 p.m., April 1 – September 30, Monday-Friday, 8 a.m. – 1 p.m. 

If you opt out of the MPPP, it won't change your Medicare drug coverage or other Medicare benefits. You'll just go back to paying for your Medicare Part D drugs at the pharmacy. 

You still have to pay any money you owe, even if you switch plans or insurance companies. You can pay your outstanding balance all at once or keep making monthly payments until the end of the year. If your plan ends in December, you'll get one last bill in January. 

You can submit a compliant or grievance related to the MPPP using the following options:

• By Phone: 1-833-957-0025 (TTY: 711). Calls to this number are toll free.
• By Mail:
  Appeals & Grievance
  Highmark Health Options Duals WV
  P.O. Box 890416
  Camp Hill, PA 17089-0416

 If you have limited income and resources, you may qualify for one of the following programs:

• Extra Help: A Medicare program that helps pay your drug costs.
• Manufacturer’s Pharmaceutical Assistance Programs (sometimes called Patient Assistance Programs (PAPs): Programs from drug manufacturers to help lower your drug costs.
• Medicare Savings Programs: State-run program that helps people pay some or all of your Medicare premiums, deductibles, copayments and coinsurance.
• State Pharmaceutical Assistance Programs (SPAPs): Programs that may 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.