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Prescription drug discounts for seniors


prescription discounts

You've probably heard about the "donut hole" if you're enrolled in a Medicare prescription drug (Part D) plan or Medicare Advantage Plan with drug coverage. To learn more about the donut hole, see "Donut hole" closing.

The donut hole is a gap in coverage after you've already spent money for covered drugs. Before health care reform, you may have had to pay the full price for prescription drugs, up to a certain amount, when you were in this gap. Now, the health care reform law is closing the donut hole so your prescriptions are more affordable.


In 2013, you pay: 47.5% of the cost when you're in the donut hole.


You'll also save when you get generic drugs:



You don't need to do anything to get the discount, it will happen as you fill your prescriptions. Remember to work with your drug plan to make sure that your records are correct.

How it impacts you


How do I know when I've reached the donut hole?

Every month that you fill a prescription, your drug plan will send you an Explanation of Benefits (EOB) showing how much you spent on your covered drugs. The EOB will tell you if you've reached the "donut hole" or coverage gap.

Are all brand-name drugs discounted?

If a drug company agrees to take part in the discount program, all covered Part D brand-name drugs they make are covered when you are in the donut hole, and more than 99% of the brand-name drugs used by Medicare members are part of the program. This means the chances of your brand-name medication being covered are good.

How do I find out if a prescription will be discounted?

Check with your drug plan or ask your pharmacist if the medications are discounted when you are in the donut hole. If a drug isn't covered, ask your doctor if there's a generic version or a different medication you can take.

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