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COVERAGE GAP DISCOUNT PROGRAM | CMS

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PART D INFORMATION FOR PHARMACEUTICAL MANUFACTURERS | CMS

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THE 2021 DOUGHNUT HOLE FOR MEDICARE PART D EXPLAINED

Updated 2 years ago

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Once you have spent up to the yearly limit, your coverage gap ends, and your drug plan helps pay for covered drugs again. For 2021, the coverage gap begins when the total amount your plan has paid for your drugs … ...

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CLOSING THE MEDICARE PART D COVERAGE GAP: TRENDS, RECENT …

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Between 2011 and 2014, average out-of-pocket costs for non-LIS Part D enrollees who reached the coverage gap decreased by $89, and then increased by $174 between 2014 … ...

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THE DONUT HOLE: MEDICARE PART D COSTS - E HEALTH INSURANCE

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Frequently Asked Questions

What are the costs in the coverage gap?

Costs in the coverage gap 1 Brand-name prescription drugs. Once you reach the coverage gap in 2019,... 2 Generic drugs. In 2019, Medicare will pay 63% of the price for generic drugs during... 3 Items that count towards the coverage gap. 4 Items that don't count towards the coverage gap. 5 If you think you should get a discount.

When does the coverage gap start for 2021?

For 2021, the coverage gap begins when the total amount your plan has paid for your drugs reaches $4,130 (up from $4,020 in 2020). At that point, you’re in the doughnut hole, where you’ll now receive a 75% discount on both brand-name and generic drugs. Prescription drug manufacturers pick up 70% of that tab and insurers 5%.

What is the gap discount data spreadsheet?

Under "Downloads," the link titled "Coverage Gap Discount Data Spreadsheet" contains three documents. The first document shows the total number of beneficiaries (by state) receiving a gap discount, the total gap discount amount, the average gap discount amount by beneficiary, and the count of PDEs with a gap discount.

Who will enter the coverage gap?

Not everyone will enter the coverage gap. The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs. Once you and your plan have spent $4,430 on covered drugs in 2022 ($4,660 in 2023), you're in the coverage gap. This amount may change each year.


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