The Medicare Prescription Payment Plan offers Medicare Part D enrollees the option to pay out-of-pocket prescription drug costs in the form of capped monthly payments instead of all at once at the pharmacy. All Medicare prescription drug plans are required to offer this benefit to enrollees.
Contract Year 2026 Medicare Advantage and Part D Final Rule (CMS-4208-F)
The Contract Year (CY) 2026 Medicare Advantage (MA) and Part D final rule codify the requirements established in the final part one and final part two guidance for 2026 and future years of the Medicare Prescription Payment Plan. To review the CY 2026 MA and Part D visit the Federal Register.
Medicare Prescription Payment Plan Part One Guidance
Part one guidance on the Medicare Prescription Payment Plan outlines requirements for Medicare Part D plan sponsors on operational topics such as identifying Medicare Part D enrollees likely to benefit from the program, the opt-in process for Part D enrollees, program participant protections, and the program data collection. These requirements apply to the first year of the program, 2025.
Fact Sheet: Medicare Prescription Payment Plan Final Part One Guidance (PDF) (February 29, 2024)
Medicare Prescription Payment Plan Final Part One Guidance (PDF) (February 29, 2024)
Summary and Sample Calculations technical memo (PDF) (July 17, 2023)
Medicare Prescription Payment Plan Part Two Guidance
Part two guidance on the Medicare Prescription Payment Plan outlines requirements for Medicare Part D plan sponsors on topics related to outreach and education, pharmacy processes, and operational considerations. These requirements apply to the first year of the program, 2025.
Fact Sheet: Medicare Prescription Payment Plan Final Part Two Guidance (PDF) (July 16, 2024)
Medicare Prescription Payment Plan Final Part Two Guidance (PDF) (July 16, 2024)
Correction - Changes to TrOOP Cost and Calculation of Maximum Monthly Cap Technical Memo (PDF) (December 20, 2024)
Frequently Asked Questions Related to the Medicare Prescription Payment Plan (PDF) (May 8, 2025)
Related Links
Communications Resources
Additional public-facing resources on the Medicare Prescription Payment Plan are available on Medicare.gov/publications, where users can easily search for materials by title, key word, or publication number. CMS encourages Medicare Part D plan sponsors to use these CMS-provided resources, such as the Medicare Prescription Payment Plan fact sheet and takeaway card, to satisfy outreach, education, and communications program requirements. Medicare Part D plan sponsors canpublish/print/repurpose the fact sheet and takeaway card in multiple languages to educate Part D enrollees and improve awareness of the Medicare Prescription Payment Plan in multiple languages.
Information Collection Requests (ICRs) for the Medicare Prescription Payment Plan
- Medicare Advantage and Prescription Drug Programs: Part C and Part D Explanation of Benefits (Approved through March 31, 2027)
- Collection of Prescription Drug Data from MA-PD, PDP and Fallout Plans/Sponsors for Medicare Part D Payments (Approved through April 30, 2027)
- Medicare Advantage and Prescription Drug Programs: Part C and Part D Medicare Advantage Prescription Drug (MARx) System Updates for the Medicare Prescription Payment Plan Program (Approved through May 31, 2027)
- Medicare Part D Reporting Requirements (Approved through August 31, 2027).
- CY 2025 Part D Reporting Requirements are also posted.
- Medicare Advantage and Prescription Drug Programs: Part C and Part D Medicare Prescription Payment Plan Model Documents (Approved through July 31, 2025)
- The model materials (ZIP) are available for download.