The Medicare Coverage Gap Discount Program provides manufacturer discounts on brand name drugs to Part D enrollees who have reached the coverage gap and are not already receiving “Extra Help.” A 50% discount on the negotiated price (excluding the dispensing fee and vaccine administration fee, if any) is available for those brand name drugs from manufacturers that have agreed to pay the discount. The plan pays an additional 5% and you pay the remaining 45% for your brand drugs.
If you reach the coverage gap, we will automatically apply the discount when your pharmacy bills you for your prescription and your Part D Explanation of Benefits (Part D EOB) will show any discount provided. Both the amount you pay and the amount discounted by the manufacturer count toward your out-of-pocket costs as if you had paid them and moves you through the coverage gap. The amount paid by the plan (5%) does not count toward your out-of-pocket costs.
You also receive some coverage for generic drugs. If you reach the coverage gap, the plan pays 35% of the price for generic drugs and you pay the remaining 65% of the price. For generic drugs, the amount paid by the plan (35%) does not count toward your out-of-pocket costs. Only the amount you pay counts and moves you through the coverage gap. Also, the dispensing fee is included as part of the cost of the drug.
If you have any questions about the availability of discounts for the drugs you are taking or about the Medicare Coverage Gap Discount Program in general, please contact the BlueCHiP for Medicare Concierge Team
BlueCHiP for Medicare Preferred, BlueCHiP for Medicare Group Preferred, BlueCHiP for Medicare Group Preferred Unlimited, and BlueCHiP for Medicare Group Preferred Unlimited 2 plan members: Because your plan offers additional gap coverage during the Coverage Gap Stage, your out-of-pocket costs will sometimes be lower than the costs described here. Please refer to Chapter 6 of your Evidence of Coverage for more information about your coverage during the Coverage Gap Stage.