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?

Archive: Donut Hole Discounts · published Apr 15, 2013

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).

You can also read more about the Donut Hole Discount in our FAQs.