How Do Prescription Drug Plans Work?

Here is important information you need to know about owning a prescription drug plan:


  • Annual Deductible — There is a deductible you must pay for a Part D plan. Your deductible may be different, or waived entirely, but the max amount you can be charged is $415 in 2019. You will pay a discounted price for your medications until you have satisfied the deductible. After that, you begin initial coverage.
  • Initial Coverage — During initial coverage, you pay a copay for your medications based on your plan’s formulary. Each prescription drug plan separates its medications into tiers. Each tier has a copy amount for which you are responsible. It is typically separated by generic drugs, preferred name brands, even more specialized medications, and etc. In 2019, the initial coverage cap is $3,820. After you and the insurance company together have paid this amount, then you enter the coverage gap.
  • The Coverage Gap – During the coverage gap, you will still generally have significant discounts for generic medications. Typically, you will pay 25% for name brand medications and 37% for generics. Your gap spending will continue until you have paid $5100 out of your own pocket in 2019.
  • Catastrophic Coverage – If you should spend past the coverage gap, your plan will begin to pay 95% of the costs of your formulary medications for the rest of the year.

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