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How to Lower Costs During the Medicare Coverage Gap (Donut Hole)



Every month after you fill prescription drugs using your Medicare Part D plan you will receive an Explanation of Benefits (EOB) for your carrier. This will show you all the medications filled and how close you are to the Coverage Gap or Donut Hole. The tips below can help you reduce costs during the Coverage Gap and the entire year.


Speak With Your Doctor

Have a discussion to see if there are lower cost alternatives to the medications your doctor has prescribed. It is a good idea to have your plan's formulary with you to make sure the drugs are covered by your plan. Using generic drugs is a great way to save and avoid the Coverage Gap.


Use Preferred Pharmacies

Each drug plan has preferred and standard pharmacies that are in-network. Preferred pharmacies will have lower costs over standard pharmacies. Refer to your pharmacy directory to learn which pharmacies are preferred for your drug plan.


Explore Mail Order Services

Typically 90 day supply mail order drugs have much lower costs than drugs filled at the retail pharmacy. Some plans will offer generic drugs at $0 copay for a 90 day supply mail order. This means lower amounts are applied to your initial coverage limit.


Pharmaceutical Assistance Programs

Your state may offer assistance programs and the drug manufacturers may have discount programs for certain high-expense and brand name drugs. These are often offered through hospitals and directly from the manufacturer websites.


Extra Help/ Low Income Subsidy (LIS)

Each state has income and assets guidelines for the Low Income Subsidy (LIS). If eligible this can help lower Part D premiums and copays. You can apply at anytime of the year for this benefit.


Perfiniti Tip: Our sister company The WellFund will help you apply for Extra Help at no charge to you. Please call (855) 365-9300 or visit https://www.thewellfund.org/contact


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