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The Doughnut Hole (Part D Coverage Gap)

How The Discount Does NOT Affect The Amount Of Time To Get Out Of The Doughnut Hole

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Discounts do not count when determining the amount you spent to get out of the doughnut hole.  This is so even though you do not actually have to pay the amount of the discount.

For example:

  • The price of a drug you buy is $205: $200, plus a $5.00 dispensing fee.
  • If the discount were 50% (to make it easy), you would only pay $100 plus $5.00 dispensing fee. The total you pay would be $105.
  • However, the entire $205 is counted while you are in the doughnut hole as if you paid that much instead of the lower discounted price.

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