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