The 2015 Donut Hole discount will increase to 55% for all brand-name medications purchased while in the Donut Hole (you pay 45% of the retail cost and get 95% of the retail price credited toward your 2015 TrOOP) and the 2015 generic Donut Hole discount will increase to 35% (you pay 65% of the retail cost).
The generic drug Donut Hole discount is paid by your Medicare Part D plan and does not count your True Out-of-Pocket costs (TrOOP - getting out of the Donut Hole).
The brand-name drug discount is split into two parts:
- The first portion of the brand-name 2015 Donut Hole discount, is a 50% discount paid by the pharmaceutical manufacturer.
- The additional 5% discount is paid by your Medicare Part D prescription drug
plan and is considered plan coverage.
Since both the generic drug Donut Hole discount and this additional 5% brand-name drug discount are paid by your Medicare prescription drug plan and considered plan coverage, these discounts do not count toward getting out of the Donut Hole or meeting your TrOOP.
Therefore, 50% of the brand-name discount – that portion paid by the drug manufacturer, will continue to count toward your TrOOP along with the 45% of the retail cost that you paid.
Here is a graph of how the brand name drug purchases are measured as the Donut Hole discount increases (until 2020):
... And here
is an example of how this works in 2015:
In 2015, if you buy a brand-name drug that has a retail cost of $100, you will
pay $45 (a 55% discount), and $95 will count toward getting you out of the Donut
Hole (or meeting your 2015 TrOOP limit of $4,700) – the $45 you paid plus
the $50 brand-name drug discount paid by the drug manufacturer.
The extra
$5 discount paid by your Medicare Part D plan will not count toward TrOOP
because it is considered plan coverage.
On the other hand, if you
purchased a generic medication with a $100 retail cost while in the 2015 Donut
Hole, you would pay $65 (a 35% discount) and only the $65 you paid would count
toward your TrOOP or Donut Hole exit point,