If, during your deductible
or while you are in the doughnut hole
(coverage gap), you find a better price on a covered Part D drug than what your plan offers, you may purchase it and still have the price count toward your true out-of-pocket (TrOOP) balance.
This is in your best interest, because you will save money and still have the purchase count toward your balance, in turn, you will exit the doughnut hole (coverage gap) sooner and enter into catastrophic coverage.
Occasionally it may be possible to get a lower price during your deductible or coverage gap (doughnut hole) at a network pharmacy
rather than the one charged by your plan.
This could happen if the pharmacy is offering a “special” price
or another discount
to all customers.
Or if you use a discount card
you may be able to receive a better cash price
for a covered Part D drug at a network pharmacy
than the plan offers.
Then, the Medicare Part D Program
allows you to purchase that drug without using your Part D benefit.
Your purchase price for the discounted drug will still count toward your total
under Part D and true out-of-pocket (TrOOP) balance
provided you notify your Part D plan
about it in the proper way.
You must take responsibility for submitting the appropriate documentation to your plan
in order to have the amount count toward your total out of pocket. The Medicare Part D Program says that plans must take receipt of such information from you and adjust your balances accordingly.
This does not apply outside of your deductible or doughnut hole
(coverage gap) period. This is to ensure that you are able to, among other things, proceed through as quickly as possible in order to reach catastrophic coverage.
For clarification and complete information on this question, please visit the CMS site: