Increase in 2013 Donut Hole discount for Generic and Brand-Name Drugs
Archive: Donut Hole Discounts · published Aug 13, 2012
Question: Who pays the Donut Hole discount and does it count toward getting out of the Coverage Gap?
The generic drug Donut Hole discount is paid by your Medicare Part D plan. The brand-name drug discount is split into two parts starting in 2013. A 50% discount is still paid by the drug manufacturer as it has been since 2011. The additional 2.5% discount is considered plan coverage – it is paid by your Medicare Part D plan. Since both the generic discount and this additional 2.5% brand-name drug discount are paid by your plan and considered plan coverage, they do not count toward getting out of the donut hole or meeting your True Out-of-Pocket costs (TrOOP). As is true in 2012, the 50% brand-name discount – that portion paid by the manufacturer, will continue to count toward TrOOP.
For example, in 2013, if you buy a brand-name drug that has a retail price of $100, you will pay $47.50 (a 52.5% discount). For this donut hole purchase, $97.50 will count toward getting out of the donut hole (or meeting your 2013 TrOOP) – the $47.50 you paid plus the $50 brand-name drug discount paid by the drug manufacturer. The extra $2.50 discount will not count toward TrOOP because it was paid by your Medicare Part D plan and is considered plan coverage.
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