Medicare Prescription Payment Plan: what your monthly bill will be
Instead of paying $718 at the pharmacy in January for a GLP-1, the Medicare Prescription Payment Plan bills about $175 a month all year.
The Medicare Prescription Payment Plan is a payment option, available since 2025 to anyone with Part D or a Medicare Advantage plan with drug coverage, that changes when you pay for covered drugs rather than how much. With an expensive drug, the Part D year is lopsided: the deductible, up to $615 in 2026, and a quarter of each fill land in the first months, until the $2,100 cap stops the bills. For Ozempic at list price that means about $718 at the counter for the first fill and the cap reached in July. With the payment plan, you pay nothing at the pharmacy for covered drugs; the plan then bills you each month, spreading what you owe over the remaining months of the calendar year. Joining in January turns the $2,100 into twelve bills of $175. Medicare.gov is explicit that it may help manage monthly expenses but does not save money or lower drug costs.
Your monthly bill with the Payment Plan
Each monthly bill
$175
| Your 2026 share for the year | $2,100 |
| Paid at the counter in month one without the plan | $718 |
The plan spreads costs; it does not lower them. Estimate only.
Prices read by Radif Partners · Editorial policy · Method and data
How the monthly amount is set
The plan divides what you owe by the number of months left in the year. Join in January and twelve bills share the year; join in July and the same amount is spread over six, so each bill doubles. As new prescriptions are filled, later bills grow to absorb them; Medicare states that all plans use the same formula, what you would have paid at the pharmacy plus last month’s balance, divided by the months left in the year. Once your share reaches the yearly cap, there is nothing more to spread.
| Joining in | Ozempic 1 mg | Mounjaro 7.5 mg |
|---|---|---|
| January | $175 | $175 |
| April | $233 | $233 |
| July | $350 | $350 |
| October | $700 | $700 |
Who it helps
The option suits people with a high yearly share concentrated early: a GLP-1, a cancer drug, several brand drugs together. It helps little with low, steady costs, where the monthly share is already small. People with Extra Help pay fixed low copays and rarely gain from it. Medicare notes that you can join at any time in the year through your plan, and that starting after September leaves few months to spread the costs.
What it does not do
It does not lower prices, change your coinsurance or cover drugs your plan excludes. It does not apply to cash purchases made through TrumpRx or a maker’s self-pay program, nor to the $50 Medicare GLP-1 Bridge copay, which is outside Part D. In 2027 the same mechanism applies to the new $2,400 cap.
A rule of thumb
If your first pharmacy bill of the year would be more than a few hundred dollars, compare it with the monthly figure in the tool above. The total is identical; the question is only whether one large payment or twelve small ones suits your budget.
Signing up and leaving
You join through your Part D plan or Medicare Advantage plan, before or during the year; there is no cost to participate. Once you are in, your plan tells the pharmacy, and you pay nothing at the counter for covered drugs. You can leave at any time by contacting your plan: you still owe the balance, which you can pay at once or be billed monthly, and you pay the pharmacy again for new fills. If you miss a payment, the plan sends a reminder; if you do not pay by its date, you are removed from the option, without interest or fees, and your drug coverage stays.
Two examples
A person on Mounjaro for diabetes whose share for 2026 is $2,100, joining in January, gets twelve bills of $175 instead of a first pharmacy bill of about $739. A person on Eliquis alone, whose yearly share is around $1,154, pays about a hundred dollars a month at the counter after the deductible either way, and gains little from the plan beyond the first month.
The 2027 version
In 2027 the plan works the same way with the higher $700 deductible and $2,400 cap. Because semaglutide moves to a negotiated price, an Ozempic user’s yearly share falls to about $1,347, and the monthly bill from January to about $112.