Yes – but only slightly more time and you will pay less than you did last year.
In 2012, the brand-name Donut Hole discount did not lengthen the time that you were in the Coverage Gap since you got 100% credit for your brand-name drug purchase while receiving your 50% discount.
However in 2013, when you purchase a
brand-name drug while in the Donut Hole, you get a 52.5% discount on your drug purchase and you get 97.5% credit of the retail price toward exiting the Donut Hole.
That is, you receive your actual 47.5% discounted cost
plus 50% of the retail cost as the Donut Hole discount portion paid by the drug manufacturer, totaling 97.5% of the retail drug cost.
The additional 2.5% “discount” on our purchase is paid by your Medicare Part D prescription drug plan and therefore does NOT count toward your Donut Hole exit or out-of-pocket costs (
TrOOP.
So, the portion of the Donut Hole discount paid by your Medicare Part D plan does not count your 2013 TrOOP of $4,750 and may slightly lengthen the time that you are in the Coverage Gap.
For example, if you purchase a brand-name medication with a retail price of $100 while in the Coverage Gap, you will get $97.50 credit toward meeting your $4,750 exit point or out-of-pocket threshold, but you will only pay $47.50 at the pharmacy after your 52.5% Donut Hole discount.
As a note, the 21% Donut Hole discount on generic drugs is also paid by your Medicare Part D plan and therefore also does not count toward your total out of pocket spending. You can read more about the
Donut Hole Discount in our FAQs.