Medicare Part D

Save up to $5 on each Medicare Part D prescription1

Medicare Part D

Save up to $5 on each Medicare Part D prescription1

medicare part d save up to $5 on each medicare part d prescription

Donut Hole

Most Medicare Part D drug plans have a coverage gap—also known as the “donut hole”—that limits what the drug plan will cover after you’ve reached your initial coverage limit.

The 2019 standard initial coverage limit is $3,8202. Once you and your plan spend more than $3,820 on covered drugs, you’re in the donut hole coverage gap until your out-of-pocket costs reach $5,100.

What do you need to do?

In the coverage gap: You'll need to pay your premiums and out-of-pocket drug costs from the time you meet your deductible (if your plan has one) until you reach catastrophic coverage. If you have a Medicare prescription drug plan that includes coverage in the gap, you may get a discount after your plan's coverage has been applied to the drug price. The discount for brand-name drugs will apply to the remaining amount you owe.

After the coverage gap: Once your costs exceed the coverage gap ($5,100 in 2019), you’ll be in catastrophic coverage and responsible for 5% of your prescription drug costs for the rest of the year.

Good news! Walgreens provides discounted prescriptions for Part D recipients in the donut hole coverage gap.

Brand-name vs. generic discounts

For covered brand-name prescription drugs, in 2019 you pay 25%, but the entire price counts as out-of-pocket costs, which helps you get out of the donut hole.

For generic prescription drugs, you'll pay 37% of the cost in 2019. With generic drugs, only the amount you pay counts toward getting you out of the donut hole.

Here's what counts toward the coverage gap:

  • Your yearly deductible, coinsurance and copayments
  • The discount you get on brand-name drugs in the coverage gap
  • What you pay in the coverage gap

Here's what doesn't count:

  • Your drug plan premium
  • The pharmacy dispensing fee
  • What you pay for drugs that aren't covered

Who qualifies for these discounts?

You'll receive the discounts once you reach the coverage gap if:

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1 $5 savings applies to Tier 1 generics when Walgreens is a Preferred Pharmacy. Copay savings based on filling a Tier 1 generic prescription at a Preferred Pharmacy compared to a Non-Preferred Pharmacy with select plans.

2 Source: https://q1medicare.com/PartD-The-2018-Medicare-Part-D-Outlook.php

* Vaccines subject to availability. State-, age- and health-related restrictions may apply.