If my Part D plan has supplemental Gap coverage, do I get the Donut Hole discount?
A partial discount on brand-name drugs.
Only the 70% pharmaceutical manufacturer discount for your brand-name
formulary drug purchases.
If your Medicare Part D plan (PDP) (or Medicare Advantage plan (MAPD)) includes supplemental Donut Hole coverage for brand-name drugs,
you will receive an additional 70% Donut Hole discount after your plan’s Gap coverage has been applied to the retail
price of the drug (that is, the 70% pharmaceutical industry discount for brand-name drugs will apply to the remaining
amount that you owe after your Medicare plan's Gap Coverage is applied).
So, if your Medicare Part D plan offers 60% coverage on brand-name drugs in the Coverage Gap (you pay 40% coinsurance) and you purchase a
brand-name formulary prescription that has a retail price of $100, the cost of your prescription after your plan’s savings is $40.
The 70% pharmaceutical manufacturer discount is then applied to your $40 portion so that you only pay
$12.00. Please notice that only the pharmaceutical industry's portion of the
Donut Hole Discount is applied since the Medicare Part D plan is already providing additional Gap coverage.
However, the entire $40 coinsurance paid by you and the pharmaceutical manufacturer will count toward your total out-of-pocket
spending (TrOOP) limit and help you get out of the Coverage Gap a little faster.
For more details, see our FAQ: