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The Doughnut Hole (Part D Coverage Gap)

Expenses Which Count BEFORE Reaching The Doughnut Hole

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The only expenses which count toward the start of the doughnut hole are monies you spend on drugs that are on the plan's formulary

Costs which count include:

  • The annual deductible.
  • All the co-pays and co insurance you pay during the current year.
  • Plans generally require that the drugs be purchased through a pharmacy with which the plan has a relationship.

The following costs do not count toward reaching catastrophic limits:

  • The drug plan premium
  • Costs for drugs not on a plan's formulary 
  • Pharmacy dispensing fees
  • (Generally), drugs not purchased through one of the plan's pharmacies
  • The cost of drugs which are not covered by Part D coverage.

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