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If I am in the 2013 Donut Hole and I purchase a $100 generic medication, does that total retail cost of $100 go towards meeting my out of pocket limit of $4,750?
No. If you purchase a generic medication in the 2013 Donut Hole, you will receive a 21% discount on the purchase this year – but only your actual payment will count toward meeting your total out of pocket spending limit or (TrOOP).
So if you purchase a generic medication that has a retail cost of $100 while in the Donut Hole, you will pay 79% of the cost (or get a 21% discount) – but, only the $79 that you actually spend on the generic medication will count toward reaching your $4,750 TrOOP limit or 2013 Donut Hole exit point.
But, you will get 97.5% credt for your brand-name drug purchases while in the 2013 Donut Hole (you can click on the following link to read more on this site).