Not exactly - the amount credited toward TrOOP depends on whether you have purchased a brand-name or generic drug while in the Donut Hole. If you are in the Donut Hole or Coverage Gap and you purchase a formulary brand-name medication that has a retail price of $100, you will pay $25 and the
75% Donut Hole Discount will cover $75.
With the purchase of a brand-name drug, you get 95% of the $100 retail drug cost credited toward your total drug spend or
TrOOP (total out-of-pocket costs) -- the $25 you spent plus the $70 portion of the 75% discount paid by the pharmaceutical manufacter. The remaining $5 of the 75% discount is covered by your Medicare Part D plan and is not credited toward your TrOOP.
If your medication is a generic drug, your Donut Hole discount is still 75% (you pay 25%) but only the $25 you spent is credited toward your TrOOP threshold. The $75 discount or 75% generic Donut Hole discount paid by your Medicare Part D plan is
NOT counted toward your total drug spending or TrOOP.
You
click here to see how the Donut Hole discount has increased over time.