You will receive a 75% discount on all formulary drug purchases. The formulary drug tier (such as a Tier 5 Specialty Drug) does not affect your
Donut Hole discount.
So, if you purchase a Tier 5 - or even a Tier 1 generic or Preferred Multi-Source) drug in the Coverage Gap:
- You will receive the generic Donut Hole discount of 75% (you pay 25% of retail).
- With generic drugs you get credit for the 25% that you paid out-of-pocket toward meeting your out-of-pocket limit (TrOOP) and exiting the Donut Hole.
However, when you purchase a
brand-name drug in the Donut Hole:
- You will receive the brand-name Donut Hole discount of 75% (you pay 25% of retail).
- With brand-name drugs you get credit for 95% of the retail drug price (the 25% you pay plus the 70% that the brand-name pharmaceutical drug manufacturer pays) toward meeting your out-of-pocket threshold (TrOOP) and exiting the Donut Hole.
You can learn more in our frequently asked question (FAQ): “
What kind of discount can we expect in the Medicare Part D Donut Hole or Coverage Gap?”.