Denton County Living Well Magazine November/December 2016 | Page 30

Prescription Drug Plans

A

lthough the donut hole (the coverage gap in
Prescription Drug Plans [PDP]) has increased,
the co-pays will decrease. Starting in January
2017 the deductible for Part D Plans may be as
high as $400 or as low as $0. If you have a deductable, you will pay the company plan’s cost for the drug
until you reach the plan’s deductible. Most drug plans have
five tiers for the cost of the drugs in their formulary [drugs
covered by your plan]. Some plans only have a deductible
on certain tiers.
In 2017 the donut hole starts when you and your company
together reach $3,700 in your formulary yearly drug costs
(not including monthly premiums). At this point you will pay
40% for name brand drugs and 51% for generic drugs in
your plans formulary. When together, you and your company, reach $4,950 (not including monthly premium) you
will begin the Catastrophic Coverage. At this stage you will
pay $3.30 or 5%, whichever is greater, for generic drugs
and $8.25 or 5%, whichever is greater, for brand name
drugs in your plan’s formulary. All plans run from Jan. 1
through Dec. 31, 2017. There is no prorated donut hole
or gap for people joining a Prescription Drug Plan during
2017.

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DENTON COUNTY Living Well Magazine | NOVEMBER/DECEMBER 2016

By Tucker Thompson

Example of prescriptions with a $0 Deductible
Brand name Xarelto: Your PDP pays $360 and your cost
is $46 a month.
Brand name Celebrex: Your PDP pays $200 and your cost
is $46 a month.
Brand name Pataday: Your PDP pays $162 and your cost
is $46 a month.
Generic name Omeprazole: Your PDP pays $18 and your
cost is $10 a month.
TOTAL: Your PDP has paid $740 and you have paid

$148 a month.
In five months, your PDP has paid *$3,700 and out of your
pocket $740.
Example of prescriptions with donut hole or gap
$3,700 to $4,950
Xarelto company and your PDP pay 60% of $360 and you
pay 40% = $144
Celebrex company and your PDP pay 60% of $200 and
you pay 40% = $80
Pataday company and your PDP pay 60% of $162 and
you pay 40% = $64.80
Generic Omeprazole company and your PDP pay 49% of
$18 and you pay 51% = $9.18