In yesterday’s post, we gave a brief explanation of the 2011 changes for Medicare Part D prescription drug plans. Today, we will explain the details of the new policy.
The Affordable Care Act gives you a 50 percent discount on prescription drugs while you are in the donut hole (coverage gap) phase of your prescription drug plan. That simple enough to understand, but there are actually a few more points of discussion.
The 50% discount refers to all “applicable” drugs. Applicable drugs are the brand named drugs generally covered under Medicare Part D prescription plans. This includes some insulins and Part D vaccines as well as drugs that are often considered generic drugs but are actually categorized as new drug applications.
Payment for Discounted Drugs
The discount is automatic so it comes right at the point of sale. It will not, however, include the dispensing fee. Also the full cost of the drug will contribute to your out of pocket expenses so that you can move into the catastrophic coverage phase.
Prescription drug cost: $80
Dispensing fee: $3
You pay the pharmacist: $43 ($80/2 +3)
Amount designated toward your out of pocket expenses: $83 (full price without discount)
Only the companies who have applied with the CMS will be counted as applicable. The CMS provides a list of companies who are participating in the program here. To view the list you must download the “Labeler Code File.”
All Other Prescription Drugs
Generic drugs covered under your Medicare Part D prescription drug plan will offer a 7% discount at the point of purchase.
To get more information about Medicare Supplement Insurance plans, talk to one of our Medigap plan representatives today or get a free quote today.