Purchasing a formulary medication during your 2023 Medicare Part D prescription drug coverage When you purchase a Part D formulary medication with a $100 retail drug cost (or purchase a brand-name drug with a $300 retail drug cost in the Catastrophic Coverage phase) |
||||||
Retail Cost | You Pay | Your Medicare drug plan pays |
Pharma Mfgr. pays |
Federal Govern. pays |
Amount counted toward your TrOOP Threshold |
|
Initial Deductible | $100 | $100 | $0 | $0 | $0 | $100 |
Initial Coverage phase * | $100 | $25 | $75 | $0 | $0 | $25 |
Coverage Gap - brand-name ** | $100 | $25 | $5 | $70 | $0 | $95 |
Coverage Gap - generic *** | $100 | $25 | $75 | $0 | $0 | $25 |
Catastrophic Coverage (brand drug) **** | $300 | $15 | $45 | $0 | $240 | n/a |
Catastrophic Coverage (generic drug) **** | $100 | $5 | $15 | $0 | $80 | n/a |
Beginning January 1, 2024 When you purchase a Part D formulary medication with a $100 retail cost |
||||||
Retail Cost | You Pay | Your Medicare drug plan pays |
Pharma Mfgr. pays |
Federal Govern. pays |
Amount counted toward your TrOOP Threshold |
|
Initial Deductible | $100 | $100 | $0 | $0 | $0 | $100 |
Initial Coverage phase * | $100 | $25 | $75 | $0 | $0 | $25 |
Coverage Gap - brand-name ** | $100 | $25 | $5 | $70 | $0 | $95 |
Coverage Gap - generic *** | $100 | $25 | $75 | $0 | $0 | $25 |
Catastrophic Coverage (brand drug) **** | $100 | $0 | $20 | $0 | $80 | n/a |
Catastrophic Coverage (generic drug) **** | $100 | $0 | $20 | $0 | $80 | n/a |
"In 2024, the premium stabilization provision [of the IRA] reduced the increase in the base beneficiary premium by 14 percentage points; the base beneficiary premium will increase by 6% in 2024 to $34.70 [from the 2023 base premium of $32.74]. Without premium stabilization, the 2024 base beneficiary premium would have been $39.35, or $4.65 higher [or 20% higher]."(see: https://www.cms.gov/newsroom/fact-sheets/ cms-releases-2024-projected-medicare-part-d-premium- and-bid-information)
Beginning January 1, 2025 When you purchase a Part D formulary medication with a $100 retail cost |
||||||
Brand-name Drug Retail Cost |
You Pay | Your Medicare drug plan pays |
Pharma Mfgr. pays |
Federal Govern. pays |
Amount counted toward your RxMOOP Threshold |
|
Initial Deductible (if any) |
$100 | $100 | $0 | $0 | $0 | $100 |
Initial Coverage phase - brand-drugs * | $100 | $25 | $65 | $10** | $0 | $25 |
Initial Coverage phase - generic-drugs * | $100 | $25 | $75 | $0 | $0 | $25 |
Catastrophic Coverage (brand drug) **** | $100 | $0 | $60 | $20 | $20 | n/a |
Catastrophic Coverage (generic drug) **** | $100 | $0 | $60 | $0 | $40 | n/a |