if the person was referring to the 75% Donut Hole discount
that you receive for all formulary drugs if you enter the Coverage Gap or Donut Hole. In addition, a few Medicare drug plans may also offer additional coverage in the Gap.
For example, the Donut Hole discount provides Medicare Part D prescription drug plan members with a 75% discount (you pay 25% of retail) on all formulary brand-name
drugs purchased in the Coverage Gap and a 75% discount (you pay 25% of retail) on
all formulary generic drugs purchased in the Coverage Gap. You can click
here to read more
about the Donut Hole discount.
Supplemental coverage in the Donut Hole in addition to the 75% Donut Hole discount
However, each year, a few
Medicare Part D plans (or Medicare Advantage plans) also provide supplemental Donut Hole coverage
for their formulary drugs. For example, a Medicare Part D plan may
continue to cover some Tier 3 Brand-name Drugs when you enter the Donut
Hole at a $47 co-pay. In this situation, you will receive the 70% Donut Hole discount paid by the brand-name drug manufacturer in addition to the plan’s supplemental Donut
Hole coverage (not the full 75% discount, but just the 70% paid by the drug manufacturers).
As an example, if you purchase a brand-name drug in the Donut Hole that has a negotiated retail cost of $200, and your Medicare Part D plan has coverage in the Coverage Gap for this medication, lets say a $90 copay, your actual cost for the purchase of this medication while in the Donut Hole would be $27 ($90 co-pay x 30%).