2025 PDP-Planner Out-of-Pocket Cost Calculation Summary: | |
Summary of the annual retail cost of your drugs:
|
|
Percentage of Generic vs. Brand drug purchases used: | |
0% Generic / 100% Brand (not vaccine adjusted) | |
Your total annual Out-of-Pocket Costs without premium: | $1,518.75 |
2025 PDP-Planner Out-of-Pocket Cost Calculation Details | |||||||
Month |
Plan Phase |
Who Pays | Total Retail |
||||
You | Plan | Mfgr | Gov | ||||
$$ | 1: Jan | Initial Coverage | $643.75 | $1,732.75 | $198.50 | $0.00 | $2,575.00 |
e:2:b amtNoMfgrDiscount: 590 usable: 2575You are still in the Initial Coverage phase, you pay 25% of your Rx costs ($2,575.00). For your brand-name drug costs ($1,985.00), your drug plan pays 65% and the drug manufacturer 10%** Your costs so far: $643.75. | |||||||
$$ | 2: Feb | Initial Coverage | $25.00 | $65.00 | $10.00 | $0.00 | $2,675.00 |
You are still in the Initial Coverage phase, you pay 25% of your Rx costs
($100.00). For your brand-name drug costs ($100.00), your drug plan pays 65% and the drug manufacturer 10%** Your costs so far: $668.75. | |||||||
$$ | 3: Mar | Initial Coverage | $25.00 | $65.00 | $10.00 | $0.00 | $2,775.00 |
You are still in the Initial Coverage phase, you pay 25% of your Rx costs
($100.00). For your brand-name drug costs ($100.00), your drug plan pays 65% and the drug manufacturer 10%** Your costs so far: $693.75. | |||||||
$$ | 4: Apr | Initial Coverage | $125.00 | $325.00 | $50.00 | $0.00 | $3,275.00 |
You are still in the Initial Coverage phase, you pay 25% of your Rx costs
($500.00). For your brand-name drug costs ($500.00), your drug plan pays 65% and the drug manufacturer 10%** Your costs so far: $818.75. | |||||||
$$ | 5: May | Initial Coverage | $25.00 | $65.00 | $10.00 | $0.00 | $3,375.00 |
You are still in the Initial Coverage phase, you pay 25% of your Rx costs
($100.00). For your brand-name drug costs ($100.00), your drug plan pays 65% and the drug manufacturer 10%** Your costs so far: $843.75. | |||||||
$$ | 6: Jun | Initial Coverage | $25.00 | $65.00 | $10.00 | $0.00 | $3,475.00 |
You are still in the Initial Coverage phase, you pay 25% of your Rx costs
($100.00). For your brand-name drug costs ($100.00), your drug plan pays 65% and the drug manufacturer 10%** Your costs so far: $868.75. | |||||||
$$ | 7: Jul | Initial Coverage | $425.00 | $1,105.00 | $170.00 | $0.00 | $5,175.00 |
You are still in the Initial Coverage phase, you pay 25% of your Rx costs
($1,700.00). For your brand-name drug costs ($1,700.00), your drug plan pays 65% and the drug manufacturer 10%** Your costs so far: $1,293.75. | |||||||
$$ | 8: Aug | Initial Coverage | $25.00 | $65.00 | $10.00 | $0.00 | $5,275.00 |
You are still in the Initial Coverage phase, you pay 25% of your Rx costs
($100.00). For your brand-name drug costs ($100.00), your drug plan pays 65% and the drug manufacturer 10%** Your costs so far: $1,318.75. | |||||||
$$ | 9: Sep | Initial Coverage | $25.00 | $65.00 | $10.00 | $0.00 | $5,375.00 |
You are still in the Initial Coverage phase, you pay 25% of your Rx costs
($100.00). For your brand-name drug costs ($100.00), your drug plan pays 65% and the drug manufacturer 10%** Your costs so far: $1,343.75. | |||||||
$$ | 10: Oct | Initial Coverage | $125.00 | $325.00 | $50.00 | $0.00 | $5,875.00 |
You are still in the Initial Coverage phase, you pay 25% of your Rx costs
($500.00). For your brand-name drug costs ($500.00), your drug plan pays 65% and the drug manufacturer 10%** Your costs so far: $1,468.75. | |||||||
$$ | 11: Nov | Initial Coverage | $25.00 | $65.00 | $10.00 | $0.00 | $5,975.00 |
You are still in the Initial Coverage phase, you pay 25% of your Rx costs
($100.00). For your brand-name drug costs ($100.00), your drug plan pays 65% and the drug manufacturer 10%** Your costs so far: $1,493.75. | |||||||
$$ | 12: Dec | Initial Coverage | $25.00 | $65.00 | $10.00 | $0.00 | $6,075.00 |
You are still in the Initial Coverage phase, you pay 25% of your Rx costs
($100.00). For your brand-name drug costs ($100.00), your drug plan pays 65% and the drug manufacturer 10%** Your costs so far: $1,518.75. | |||||||
Summary |
Who Pays | Total Retail |
|||||
You | Plan | Mfgr | Gov | ||||
Totals without premium: | $1,518.75 | $4,007.75 | $548.50 | $0.00 | $6,075.00 | ||
Notes: *Copayments can influence when you enter the Catastrophic Coverage phase. ** The 10% paid by the brand-name drug manufacturer is NOT included in your TrOOP and does not count toward reaching RxMOOP. *** The Coverage Gap (Donut Hole) is eliminated in 2025. | |||||||
Legend: | |||||||
$$$ | You are responsible for 100% of your prescription (Rx) costs. This occurs during the Initial Deductible phase of coverage. (Many plans do not have an initial deductible or exclude low-cost generic drugs from the deductible. Covered insulin products and ACIP vaccines are excluded from the deductible.) | ||||||
$$ | You share your prescription (Rx) costs with your Medicare Part D plan provider and you receive a Manufacturer Discount on brand-name drug purchases. During the Initial Coverage Phase, you are responsible for 25% of your medication costs (basic or standard plans) or a copayment on enhanced plans. | ||||||
$0 | You pay $0 for your medications -- you have 100% coverage for your formulary prescription (Rx) purchases. This occurs in the Catastrophic Coverage phase. |
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