10/13/2021
𝐌𝐞𝐝𝐢𝐜𝐚𝐫𝐞 𝐏𝐚𝐫𝐭 𝐃 𝐂𝐨𝐯𝐞𝐫𝐚𝐠𝐞 𝐆𝐚𝐩 (𝐓𝐡𝐞 𝐃𝐨𝐧𝐮𝐭 𝐇𝐨𝐥𝐞)
I am starting to get calls from my customers stating they went to their pharmacy and instead of paying $47 for their tier 3 medication they are now are paying double that amount and in some cases much more. Why is this? They have entered Medicare Part D Coverage Gap - the donut hole. This means there's a temporary limit on what the drug plan will cover for drugs. Not everyone will enter the coverage gap. The coverage gap begins after you and your drug plan have spent $4130.00 for covered drugs. While in the "donut hole" you will pay 25% and the manufacturer and drug plan will pay 75%. (i.e., Eliquis costs $500 - you will pay $125 and the manufacturer and drug plan will pay $375)
Once you've spent $6,550 out-of-pocket in 2021 (which includes your yearly deductible , coinsurance,, copays and what you pay in the coverage gap) you're out of the coverage gap. Once you get out of the coverage gap (Medicare prescription drug coverage), you automatically get "catastrophic coverage." It assures you only pay a small coinsurance percentage or copayment for covered drugs for the rest of the year. However, if you just entered the "donut hole" you may or may not get out this year. It depends on how many brand name drugs you take. But the good news is that January 1 your copay will go down.
𝐍𝐨𝐭𝐞: Changing Medicare Advantage plans won't make a difference because "the donut hole" is standardized in each plan.
If you need assistance paying for your medication you can get support. For Xarelto -go to xarelto-us.com
For Eliquis - go to eliquis.bmscustomerconnect.com. inbox me for other medications
