Know about drug discounts in the
Coverage Gap
Those who reach the Coverage Gap in a Part D prescription drug plan (also called the “donut hole”) and don’t receive extra help from Medicare get a discount on covered brand-name and generic drugs they buy at a pharmacy or through mail-order. The discount is automatic, coming off the price of a prescription.
- The discount on prescribed medications will be 75%. For a prescription that costs $100, the discount would be $75.00, leaving $25.00 out-of-pocket.
- The pharmacy can add a small handling fee, typically $2 or $3, on top of that amount for brand-name drugs.
Companies that make brand-name prescription drugs must sign an agreement with Medicare to participate in the discount program. All of the covered Part D brand-name drugs they make are then covered during the Coverage Gap for that calendar year. Manufacturers that produce over 99% of the brand-name drugs used by Medicare beneficiaries participate in this program. The discounts have saved those who end up in the donut hole an average of $768.
Last updated: 12-01-2020