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Starting in 2025, you can set up a payment plan for your prescription drugs.

What is the Medicare prescription payment plan?

Starting in 2025, anyone with a Medicare drug plan or Medicare health plan with drug coverage (like a Medicare Advantage plan with Part D prescription drug coverage) can use this payment option. All plans offer this payment option and participation is voluntary.

Instead of paying your pharmacy directly, you will pay FHCP Medicare payments over the year for your drugs.

No matter how you choose to pay, you will pay no more than $2,000 out of pocket for your Medicare Part D prescription drugs in 2025. And taking part in the Medicare prescription drug payment plan will not change your cost sharing (copays and coinsurance) for your prescription drugs. The plan simply allows you to pay these costs over time instead of all at once.

Why set up a payment plan?

You can set up a payment plan to spread out your prescription drug costs over the year, instead of paying them all at once. This may help you if you need higher-cost drugs earlier in the year and cannot pay it at one time.

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 time to spread out your drug costs.

Find answers to your questions and find out if you’re likely to benefit from this payment option on Medicare.gov.

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.

How does the Medicare prescription drug payment plan work?

Examples of how a monthly bill is calculated
Example 1:
Let’s say you take several high-cost drugs that have a total out-of-pocket cost of $500 each month. In January 2025, you join your plan’s Medicare prescription payment plan.

Your first month’s bill in the payment plan is calculated differently than your bill for the rest of the months in the year:
First, we figure out your “maximum possible payment” for the first month:

$2,000 [annual out-of-pocket maximum]
– $0 [no out-of-pocket costs before using this payment option] = $2,000
÷ 12 [remaining months in the year]
= $166.67

Then, we figure out what you’ll pay for January:
– Compare your total out-of-pocket costs for January ($500) to the “maximum possible payment” we just calculated: $166.67.
– Your plan will bill you the lesser of the two amounts. So, you’ll pay $166.67 for the month of January.
– You have a remaining balance of $333.33 ($500-$166.67).

For February and the rest of the months left in the year, we calculate your payment differently:
$333.33 [remaining balance] + $500 [new costs] = $833.33
÷ 11 [remaining months in the year]
=$75.76
Your balance for February is $757.57 to carry over next month.

We’ll calculate your March payment like we did for February:
$757.57 [remaining balance] + $500 [new costs] = $1,257.57
÷ 10 [remaining months in the year]
=$125.76
Your balance for March is $1,131.81 to carry over next month.

In April, when you refill your prescriptions again, you’ll reach the annual out-of-pocket maximum for the year ($2,000 in 2025).
You’ll continue to pay what you already owe and get your prescription(s), but after April you won’t add any new out-of-pocket costs for the rest of the year.

$1,131.81 [remaining balance] + $500 [new costs] = $1631.81
9 [remaining months in the year]
= $166.67 [your “maximum possible payment” for the first month]
= $75.76 [your payment for February]
= $125.76 [your payment for March]
= $181.31 [your payment for April and all remaining months in the year]

Even though your payment varies each month, by the end of the year, you’ll never pay more than:
The total amount you would have paid out-of-pocket (if this is less than $2,000) or
the total annual out-of-pocket maximum ($2,000 in 2025).

Remember, this is just your monthly payment for your out-of-pocket drug costs. You still need to pay your health or drug plan’s premium (if you have one) each month.

What if I don’t pay my bill?

You are required to pay your bill, but you won’t pay any fees if your payment is late.

Make sure to always pay your health or drug plan monthly premium first (if you have one), so you don’t lose your drug coverage.

If you enroll in the prescription drug payment plan, call Capital Rx at 1-877-282-2779 (TTY: 1-800-955-8770), 24 hours a day, 7 days a week, if you think we made a mistake about your bill.

How do I set up a payment plan for my prescription drugs with FHCP Medicare?

You can set up a payment plan now for 2025 or sign up any time during 2025.

Log in to your online FHCP Medicare member portal account to set up your prescription drug payment plan.

Or visit Login (cap-rx.com) and follow the prompts to set up your payment plan account.

If you have questions, please call Capital Rx, who is administering this new program on our behalf, at 1-877-282-2779 (TTY 1-800-955-8770), 24 hours a day, 7 days a week.

Are there extra fees for setting up a payment plan?

It’s no extra cost to you to set up a payment plan for your prescription drugs.

How to enroll retroactively when you have an urgent prescription drug to fill.

Call Capital Rx at 1-877-282-2779 (TTY 1-800-955-8770), 24 hours a day, 7 days a week.

How to file a grievance

You have the right to file a grievance or submit an appeal and ask us to review your coverage determination.

Rights and Responsibilities upon Disenrollment: You have the right to ask us to reconsider this decision. You can ask us to reconsider by filing a grievance with us. You can look in your “Evidence of Coverage” for information about how to file a grievance, contact us at 1-833-866-6559 (TTY users: 1-800-955-8770) or click here for more information.

Upon request, Medicare Advantage and Prescription Drug plans are required to disclose grievance and appeals data to enrollees in accordance with regulatory requirements.

You can contact us at 1-833-866-6559 (TTY users: 1-800-955-8770) to request this information.

Hours: 8:00 a.m. to 8:00 p.m. local time, seven days a week, from October 1 through March 31, except for Thanksgiving and Christmas. From April 1 through September 30, our hours are 8:00 a.m. to 8:00 p.m. local time, Monday through Friday, except for major holidays

Need help paying for your prescription drugs?

If you cannot afford your medications, you may want to apply for Extra Help from Medicare. This program helps people pay for their Part D drugs.

To see if you qualify for getting Extra Help, call:

  • 1-800-MEDICARE (1-800-633-4227). TTY: 1-877-486-2048, 24 hours a day/7 days a week
  • The Social Security Office at 1-800-772-1213, 8am and 7pm, Monday through Friday (TTY: 1-800-325-0778)
  • Your State Medicaid Office 1-888-419-3456, Monday through Friday 8am to 5pm ET (TTY: 1-800-955-8771)

Find Part D forms

View and download important forms and documents about your FHCP Medicare plan.

Medicare Prescription Payment Plan form