Figure 1: Comparison of a Non-LIS Beneficiary’s Out-of-Pocket Spending for Prescription Drugs in the Coverage Gap under the Standard Benefit in 2011, without and with the Medicare Coverage Gap Discount Program in Place
This image is excerpted from a U.S. GAO report:
www.gao.gov/products/GAO-12-914
MEDICARE PART D COVERAGE GAP: Discount Program Effects and Brand-Name Drug Price Trends
Note: Once the catastrophic threshold is reached, the beneficiary pays the greater of 5 percent coinsurance or copayments of $2.50 for generics or preferred multiple-source drugs and $6.30 for other drugs, including brand-name drugs. A multiple-source drug is one for which there is at least one other drug product rated as therapeutically and pharmaceutically equivalent. Therapeutically and pharmaceutically equivalent drugs have the same active ingredients and clinical effects. A preferred drug is a drug that is included on a plan’s formulary for which beneficiary cost-sharing is lower (i.e., the drug has a preferred position), compared to a nonpreferred drug. a This side of the figure is an example of what beneficiary out-of-pocket spending for prescription drugs would have been in 2011 if the Coverage Gap Discount Program had not been implemented.
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