No.  In this situation, you will pay your initial copayment (or cost sharing) for the $1,894 drug plus the difference of the retail amount that takes you into your plan's Donut Hole or Coverage Gap - less any applicable Donut Hole Discount applied to the balance of the purchase that falls into the Donut Hole.

As background, a prescription drug purchase that exceeds your Medicare prescription drug plan's Initial Coverage Limit and then crosses into the Coverage Gap or Donut Hole portion of your Medicare Part D plan is known as a "straddle claim" because it will cross to different phases of your Medicare Part D coverage.

Here is how we can estimate your straddle claim cost at the pharmacy:

• Your plan's Initial Coverage Limit: $2,600
  
  
• Your current balance in the Initial Coverage Phase: $930
  
  
• What you have remaining before reaching the Donut Hole or Coverage Gap Phase: $1,670 ($2,600 - $930)
  
  
• You purchase a brand-name drug with a retail cost of: $1,894
  
  
• Your cost-sharing is 30% coinsurance for this drug during your Initial Coverage Phase
  
  
• Your cost or Medicare Part D plan's cost-sharing amount for this portion of the purchase that occurs in the Initial Coverage phase (30% of the $1,670): $501
  
  
• Your additional cost for the balance of the retail price that "straddles" or carries over into the Donut Hole or Coverage Gap is ($1,894 - $1,670): $224
  
  
• You receive a 75% discount on all formulary drugs in the Donut Hole (so you pay 25% of the retail balance).
  
  
• Your additional cost in the Donut Hole is 25% * $224:  $56
  
  
• Your total cost for this "straddle claim" purchase would be $501 + $56 = $557
  

And now for a little more detail . . .

Step #1 - Cost in the Initial Coverage Limit

In this example, the first $1,670 of your $1,894.70 drug purchase will still be in your Initial Coverage Phase and you will be charged only your normal Medicare Part D plan 30% coinsurance for the first $1,670 - or $501.

Step #2 - Cost in the Coverage Gap or Donut Hole

The second portion of your purchase, $224, falls into the Coverage Gap or Donut Hole and you will receive a 75% discount on this part of the purchase (or pay 25% of $224 = $56).

So - your entire purchase would then be calculated to what you paid in the Initial Coverage Phase plus what you pay in the Donut Hole or Coverage Gap: $501 + $56 = $557.

Please note that since this purchase was for a brand-name medication, you would get 95% credit of the $224 portion of the purchase toward exiting the Donut Hole (or your TrOOP limit $7,400 in 2023 and increasing to $8,000 in 2024).

Click here if you wish to see the other Medicare Part D plan standard plan parameters since 2006:  q1medicare.com/PartD-The-MedicarePartDOutlookAllYears.php

Click here if you wish to see how the Donut Hole Discount changes until 2020: Q1FAQ.com/470