You will pay
$62.50 in the 2024 Donut Hole or Coverage Gap and
$0 in the Catastrophic Coverage phase for all formulary drug purchases.
Once the total retail value of your Medicare Part D drug purchases exceeds your
Initial Coverage Limit of
$5,030 in 2024,
you will enter the 2024 Donut Hole or Coverage Gap and pay
25% of the retail price
for all formulary medications – assuming that your Medicare prescription drug plan
does not provide any coverage in the Donut Hole.
However, you will get a credit of 95% of the retail cost ($237.50) toward meeting your
annual total out-of-pocket limit (
TrOOP)
of $8,000, because your medication is a brand-name drug. If it were a generic drug, you would still pay 25%, but you would only get credit toward TrOOP
for the 25% you paid.
If you exceed the
$8,000 out-of-pocket limit in 2024,
you will reach the Catastrophic Coverage phase of your Medicare Part D coverage and
you will pay nothing for your formulary medication purchases for the remainder of the year.
Keep in mind that 2023 was the last year that Medicare Part D beneficiaries paid cost-sharing in the Catastrophic Coverage phase. For plan year
2024 and beyond,
the
Inflation Reduction Act (IRA) of 2022 eliminates beneficiary cost-sharing in the Catastrophic Coverage phase.
For more information, please see our FAQ:
Will my Catastrophic Coverage drug costs change over the years?
As a reminder: You can use our Drug Finder
(
Q1Rx.com) to see the
average retail cost of any medication covered by your Medicare prescription drug
plan.
But remember, your actual negotiated retail drug prices
can vary pharmacy-to-pharmacy and even week-to-week at the same pharmacy.