When you purchase a formulary medication |
||||||
Retail cost |
You pay |
Your |
Pharma Mnfgr pays |
Gov. pays |
Amount toward your TrOOP |
|
Initial
Deductible * |
$200 |
$200 |
$0 |
$0 |
$0 |
$200 |
Initial Coverage Phase ** |
$200 |
$30 |
$70 |
$0 |
$0 |
$30 |
Coverage Gap - brand-name *** |
$200 |
$90 |
$10 |
$100 |
$0 |
$190 |
Coverage Gap - generic **** |
$200 |
$116 |
$84 |
$0 |
$0 |
$116 |
Catastrophic Coverage brand-name ***** |
$200 |
$10 |
$30 |
$0 |
$160 |
$10 |
* Retail Cost toward ICL
** $30 co-pay (Retail Cost toward ICL)
*** 55% Brand-Name Donut Hole Discount in 2016
**** 42% Generic Donut Hole Discount in 2016
***** 5% of retail or $7.40 for brand medications, whichever is higher (80% paid by Medicare, 15% paid by Medicare plan, and around 5% by plan member)