Total Drug Expenditures

includes enrollee payment, plan payment, & manufacturer discount

CATASTROPHIC COVERAGE

Plan pays
95%

Enrollee Pays
Greater of 5% or $8.25 brand/$3.30 generic

COVERAGE GAP (DONUT HOLE)

Plan Pays
49% for generic drugs and 10% for brand-name drugs

Drug Manufacturer Discount
50% for brand-name drugs (discount applies as an enrollee out-of-pocket expenditure)

Enrollee Pays
51% of cost of generic drugs and 40% of cost of brand-name drugs

INITIAL COVERAGE

Plan Pays
75%
($2475)

Enrollee Pays
25%
($875)

DEDUCTIBLE

Enrollee Pays:  $400

Enrollee Pays

out-of-pocket costs