No. In 2013, when you purchase a
brand-name drug while in the Donut Hole or Coveage Gap, you get an automatic
52.5% Donut Hole discount on your prescription purchase -- and credit for 97.5% of the drug’s retail price yoward exiting the Donut Hole.
In other words, you get credit for what you spent (47.5% of the retail price) plus the 50% Donut Hole discount paid by the drug manufacturer, totaling 97.5% of the retail drug cost.
The additional 2.5% of the “Donut Hole discount” is paid by your Medicare Part D plan and therefore does NOT count toward exiting the Donut Hole or reaching your out-of-pocket costs (
TrOOP).
For example, if you are in the 2013 Donut Hole and purchase a medication that has a retail cost of $100, you will pay $47.50 for the medication and get $97.50 credit toward meeting your 2013 out-of-pocket limit of $4,750.
On the other hand, if the $100 medication you purchase in the Donut Hole was a generic drug, you would get a
21% Donut Hole discount in 2013 and pay $79 dollars for the medication. You would then get credit only for the actual $79 you spent toward meeting the $4,750 Donut Hole exit point or out-of-pocket threshold.
You can read more about the
Donut Hole Discount in our FAQs.