If, during your deductible or while you are in the doughnut hole (coverage gap), you find a better price on a covered Part D drug than what your plan offers, you may purchase it and still have the price count toward your true out-of-pocket (TrOOP) balance.

This is in your best interest, because you will save money and still have the purchase count toward your balance, in turn, you will exit the doughnut hole (coverage gap) sooner and enter into catastrophic coverage.

Occasionally it may be possible to get a lower price during your deductible or coverage gap (doughnut hole) at a network pharmacy rather than the one charged by your plan.

This could happen if the pharmacy is offering a “special” price or another discount to all customers.  Or if you use a discount card you may be able to receive a better cash price for a covered Part D drug at a network pharmacy than the plan offers.

Then, the Medicare Part D Program allows you to purchase that drug without using your Part D benefit.  Your purchase price for the discounted drug will still count toward your total under Part D and true out-of-pocket (TrOOP) balance provided you notify your Part D plan about it in the proper way.

You must take responsibility for submitting the appropriate documentation to your plan in order to have the amount count toward your total out of pocket. The Medicare Part D Program says that plans must take receipt of such information from you and adjust your balances accordingly.

This does not apply outside of your deductible or doughnut hole (coverage gap) period. This is to ensure that you are able to, among other things, proceed through as quickly as possible in order to reach catastrophic coverage.

For clarification and complete information on this question, please visit the CMS site:

http://questions.cms.hhs.gov/cgi-bin/cmshhs.cfg/php/enduser/std_adp.php?p_faqid=7944