Accumulating Drug Costs

Let us suppose that we fill a prescription at the Local Pharmacy for which our Insurance Plan has negotiated a price of  $40.00 for a 90 day supply of a drug and our Co- pay amount is $12.00 ( $4.00 per month Co-pay x three months ).

In this case we would pay $12.00 when we pick up the prescription and our Plan would pay the balance of $28.00 to the pharmacy. 

The ENTIRE $40.00 would then be charged to our accumulating " Total Drug Costs ". 

This really does not seem fair - since our Insurance Plan has only paid out $28.00 on our behalf. 

Once this " Total Drug Cost " reaches a certain amount ($2960.00 for 2015 ) we are now responsible for the total amount ( $12.00 + $28.00 = $40.00 ). 

Once we become responsible for the total amount, we are in " The Medicare Gap " also known as " The Medicare Part D Donut Hole ". 




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