Question:
When looking for a Medicare Part D plan with some Gap Coverage, we could not understand the difference between
preferred generics and those listed as
generics. Some Part D plans cover "
all preferred generics" or "
some generics" or "
all generics". What is the difference between
generics?
Answer:
The short answer to the question is that these various "generic drug" terms have no particular meaning outside of specific Part D plans.
One problem with Part D drug data is that it is often not “normalized” – in other words, the terms are not standardized across plans. One Part D plan’s “Preferred Generic” list is not necessarily the same as another Plan’s “Preferred Generic” list.
How is it that we have new classes of Generics inside the general term Generics? Our guess is that, in an effort to keep monthly premiums down, some Part D plans are limiting their Gap or Doughnut Hole coverage and these different generic drug terms may be a subtle way for the Part D plan to say: “not all generics drugs are being covered through the Doughnut Hole or Coverage Gap.” However, in most cases, the most common generic medications are included in these lists.
An IMPORTANT Note: The Co-payments of covered Generics do not always stay the same in the Doughnut Hole. For instance, you may have a $2 or $5 copayment for a covered generic drug that, in the Doughnut Hole will have an increased copayment of $15 or $20. Other plans offer a percentage (%) of the cost of generics as the coinsurance in the Doughnut Hole (see the example below).Here is a random example of how "Generics" in the doughnut hole or coverage gap actually vary across plans - (Please note, these Part D plans were also chosen at random from the Medicare.gov site and represent no endorsement or criticism).
| AdvantraRx Premier Plus | AARP MedicareRx Enhanced | CIGNA Medicare Rx Plan Three | First Health Part D-Select | Humana PDP Complete | SilverScript Complete | |
| All Preferred Generics | All Preferred Generics | Some Generics | All Preferred Generics | All Preferred Generics | All Generics | |
| CLOTRIMAZOLE/BETAMETHASONE DIPROPIONATE CRE DIPROP | $13.49 | $7 | $12.86 | $13.49 | $4 | $7 |
| ETODOLAC TAB 500MG | $15 | $7 | $7.44 | $20 | $4 | $7 |
| METHOCARBAMOL TAB 750MG | $9.77 | $8.93 | $5.45 | $9.77 | $4 | $5.82 |
| TRIAMTERENE/HCTZ TAB 37.5-25 | $10.78 | $7 | $1.84 | $10.78 | $4 | $7 |
| VERAPAMIL HCL CR TAB 240MG | $15 | $7 | $4.76 | $20 | $4 | $7 |
| Regular Generic Co-Pay |
$2 | $ 7 | $6 | $5 | $4 | $7 |
The yellow highlighted numbers represent the Part D plan's negotiated retail generics below the co-payment. In such a case, the Part D plan Member pays the lesser of the retail or the co-payment.
The green highlighted values represents what the Medicare.gov site (as of 11/13/2007) shows as non-covered generics.
The blue highlighted values are the normal generic or Tier I copayments during the Inital Coverage Period - before the coverage gap.