No. Only Medicare Part D prescription drugs found on your formulary qualify for the
brand-name or generic 75% Donut Hole discount.
Non-formulary medications, over-the-counter (OTC) drugs, and medications
excluded
from the Medicare Part D program by law, do not qualify for a Donut Hole discount
and your non-formulary drug purchases do not count toward your total
out-of-pocket drug spending (
TrOOP)
limit (
$7,400 in 2023 and
$8,000 in 2024) – the amount you need to spend before exiting the Donut Hole.
In fact, even so-called
"Bonus" or "Supplemental" drugs that are covered by your Medicare Part D plan, but excluded from the Medicare Part D program (such as ED drugs, most vitamins, and cough or cold medicine) do not receive the Donut Hole discount and are not counted toward your TrOOP.
Remember, if you are using a non-formulary Medicare Part D medication, you can ask your plan to grant a
Formulary
Exception -- a type of Coverage Determination so that your drug is covered by your Medicare plan and therefore is considered a formulary medication and counts toward TrOOP and receives the Donut Hole discount.
If your Medicare Part D plan denies your
Formulary Exception request, you have
the right to appeal your plan’s decision through several levels of review. For more information, you can
click
here to read about Formulary Exceptions.