What the Medicare Prescription Payment Plan is
Every Part D plan, including Medicare Advantage plans with drug coverage, must offer the payment plan. A participating enrollee pays $0 at the pharmacy counter for covered Part D drugs. The plan then bills the enrollee monthly. Medicare.gov is explicit that it does not save money or lower drug costs. It only changes when the money is due.
The monthly bill has a cap. It equals the remaining out-of-pocket threshold divided by the months left in the year, recalculated each month. The threshold is $2,100 in 2026 and $2,400 in 2027, so joining early spreads costs more evenly. Under the CY2026 rule, plans must automatically renew participation each year unless the enrollee opts out.
Pharmacies play a narrow role. When a single claim reaches $600 out of pocket, the plan flags the pharmacy, which hands the patient a standardized Likely to Benefit notice. Staff are not required to counsel. Rivvi is a HIPAA-compliant AI workspace where a pharmacy can find high-cost patients in its fill data and reach them through its action layer.