Changes to Medicare Part D

Federal Inflation Reduction Act

Due to the federal Inflation Reduction Act, there have been several improvements to the Medicare Part D benefit including:

Elimination of the Coverage Gap or “Donut Hole” – In previous years the Part D benefit was designed with a gap in prescription drug coverage. That coverage gap has been eliminated in 2025, which means your prescription drugs will be covered throughout the year.
In 2026 the maximum out-of-pocket for Part D drugs is capped at $2,100.
Select Insulins are covered at no more than $35 (for a 30-day supply).*

Medicare Prescription Payment Plan

Beginning in 2025, the Inflation Reduction Act added a new payment option called the Medicare Prescription Payment Plan. This program provides a new payment option that helps you manage your prescription drug costs by spreading them across the calendar year (January–December).

You pay $0 at the pharmacy for all covered Part D prescriptions
You will receive a monthly bill from Prominence with your share of drug costs

Note: This program can only help you manage your expenses—it can’t save you money or lower your drug costs.

Note: If you enrolled in this program in 2025 and are still enrolled at the end of the year, you will be automatically enrolled in this program at the beginning of 2026.

Who benefits from this program?

If you have spent more than $2,000 in Part D drug costs in the previous year
If you spend more than $600 on a single prescription in the previous year

You would likely not benefit from this program 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 get or are eligible for Extra Help from Medicare (also called Low-Income Subsidy or LIS)
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 to opt-in to the Medicare Prescription Payment Plan?

If you are a current member, log in to your secure member portal to opt-in online.

You may also opt-in by calling the number on your member ID card or downloading the enrollment form to print and mail to us (coming soon).

What happens if you opt out?

You have the option to opt out of this program by calling Member Services at any time.

You will begin to pay the pharmacy directly for your Part D drug costs
You will continue to receive monthly bills for your outstanding balance for costs incurred while enrolled in the program (you will have the option to pay the balance in full at any time)
You will be required to pay the full amount you owe before you can participate in the program again in the future