Explanation of Monthly Drug Costs
1 This number includes the amount you pay for drug copays and drug plan premiums, but not any health coverage premiums your plan may charge.
| Month |
Your Cost1
| ||||
|---|---|---|---|---|---|
| January | Monthly Fee | You Pay | |||
| Drug Premium | $41.00 | ||||
| Drug | Covered Drug | Phase | Full Cost | You Pay | |
| Advair Diskus AER 250/50 | Yes | Deductible / Initial Cost | $274.77 | $165.38 | |
| levothyroxine sodium TAB 200MCG | Yes | Deductible | $7.59 | $7.59 | |
| levothyroxine sodium TAB 25MCG | Yes | Deductible | $5.01 | $5.01 | |
| Nexium CAP 40MG | Yes | Deductible | $229.54 | $229.54 | |
| What you’ll spend in January: | $448.52 | ||||
| February | Monthly Fee | You Pay | |||
| Drug Premium | $41.00 | ||||
| Drug | Covered Drug | Phase | Full Cost | You Pay | |
| Advair Diskus AER 250/50 | Yes | Initial Cost | $274.77 | $118.15 | |
| levothyroxine sodium TAB 200MCG | Yes | Initial Cost | $7.59 | $2.00 | |
| levothyroxine sodium TAB 25MCG | Yes | Initial Cost | $5.01 | $2.00 | |
| Nexium CAP 40MG | Yes | Initial Cost | $229.54 | $50.50 | |
| What you’ll spend in February: | $213.65 | ||||
| March | Monthly Fee | You Pay | |||
| Drug Premium | $41.00 | ||||
| Drug | Covered Drug | Phase | Full Cost | You Pay | |
| Advair Diskus AER 250/50 | Yes | Initial Cost | $274.77 | $118.15 | |
| levothyroxine sodium TAB 200MCG | Yes | Initial Cost | $7.59 | $2.00 | |
| levothyroxine sodium TAB 25MCG | Yes | Initial Cost | $5.01 | $2.00 | |
| Nexium CAP 40MG | Yes | Initial Cost | $229.54 | $50.50 | |
| What you’ll spend in March: | $213.65 | ||||
| April | Monthly Fee | You Pay | |||
| Drug Premium | $41.00 | ||||
| Drug | Covered Drug | Phase | Full Cost | You Pay | |
| Advair Diskus AER 250/50 | Yes | Initial Cost | $274.77 | $118.15 | |
| levothyroxine sodium TAB 200MCG | Yes | Initial Cost | $7.59 | $2.00 | |
| levothyroxine sodium TAB 25MCG | Yes | Initial Cost | $5.01 | $2.00 | |
| Nexium CAP 40MG | Yes | Initial Cost | $229.54 | $50.50 | |
| What you’ll spend in April: | $213.65 | ||||
| May | Monthly Fee | You Pay | |||
| Drug Premium | $41.00 | ||||
| Drug | Covered Drug | Phase | Full Cost | You Pay | |
| Advair Diskus AER 250/50 | Yes | Initial Cost | $274.77 | $118.15 | |
| levothyroxine sodium TAB 200MCG | Yes | Initial Cost | $7.59 | $2.00 | |
| levothyroxine sodium TAB 25MCG | Yes | Initial Cost | $5.01 | $2.00 | |
| Nexium CAP 40MG | Yes | Initial Cost | $229.54 | $50.50 | |
| What you’ll spend in May: | $213.65 | ||||
| June | Monthly Fee | You Pay | |||
| Drug Premium | $41.00 | ||||
| Drug | Covered Drug | Phase | Full Cost | You Pay | |
| Advair Diskus AER 250/50 | Yes | Initial Cost / Gap | $274.77 | $124.06 | |
| levothyroxine sodium TAB 200MCG | Yes | Initial Cost | $7.59 | $2.00 | |
| levothyroxine sodium TAB 25MCG | Yes | Initial Cost | $5.01 | $2.00 | |
| Nexium CAP 40MG | Yes | Initial Cost | $229.54 | $50.50 | |
| What you’ll spend in June: | $219.56 | ||||
| July | Monthly Fee | You Pay | |||
| Drug Premium | $41.00 | ||||
| Drug | Covered Drug | Phase | Full Cost | You Pay | |
| Advair Diskus AER 250/50 | Yes | Gap | $274.77 | $130.52 | |
| levothyroxine sodium TAB 200MCG | Yes | Gap | $7.59 | $6.00 | |
| levothyroxine sodium TAB 25MCG | Yes | Gap | $5.01 | $3.96 | |
| Nexium CAP 40MG | Yes | Gap | $229.54 | $109.03 | |
| What you’ll spend in July: | $290.51 | ||||
| August | Monthly Fee | You Pay | |||
| Drug Premium | $41.00 | ||||
| Drug | Covered Drug | Phase | Full Cost | You Pay | |
| Advair Diskus AER 250/50 | Yes | Gap | $274.77 | $130.52 | |
| levothyroxine sodium TAB 200MCG | Yes | Gap | $7.59 | $6.00 | |
| levothyroxine sodium TAB 25MCG | Yes | Gap | $5.01 | $3.96 | |
| Nexium CAP 40MG | Yes | Gap | $229.54 | $109.03 | |
| What you’ll spend in August: | $290.51 | ||||
| September | Monthly Fee | You Pay | |||
| Drug Premium | $41.00 | ||||
| Drug | Covered Drug | Phase | Full Cost | You Pay | |
| Advair Diskus AER 250/50 | Yes | Gap | $274.77 | $130.52 | |
| levothyroxine sodium TAB 200MCG | Yes | Gap | $7.59 | $6.00 | |
| levothyroxine sodium TAB 25MCG | Yes | Gap | $5.01 | $3.96 | |
| Nexium CAP 40MG | Yes | Gap | $229.54 | $109.03 | |
| What you’ll spend in September: | $290.51 | ||||
| October | Monthly Fee | You Pay | |||
| Drug Premium | $41.00 | ||||
| Drug | Covered Drug | Phase | Full Cost | You Pay | |
| Advair Diskus AER 250/50 | Yes | Gap | $274.77 | $130.52 | |
| levothyroxine sodium TAB 200MCG | Yes | Gap | $7.59 | $6.00 | |
| levothyroxine sodium TAB 25MCG | Yes | Gap | $5.01 | $3.96 | |
| Nexium CAP 40MG | Yes | Gap | $229.54 | $109.03 | |
| What you’ll spend in October: | $290.51 | ||||
| November | Monthly Fee | You Pay | |||
| Drug Premium | $41.00 | ||||
| Drug | Covered Drug | Phase | Full Cost | You Pay | |
| Advair Diskus AER 250/50 | Yes | Gap | $274.77 | $130.52 | |
| levothyroxine sodium TAB 200MCG | Yes | Gap | $7.59 | $6.00 | |
| levothyroxine sodium TAB 25MCG | Yes | Gap | $5.01 | $3.96 | |
| Nexium CAP 40MG | Yes | Gap | $229.54 | $109.03 | |
| What you’ll spend in November: | $290.51 | ||||
| December | Monthly Fee | You Pay | |||
| Drug Premium | $41.00 | ||||
| Drug | Covered Drug | Phase | Full Cost | You Pay | |
| Advair Diskus AER 250/50 | Yes | Gap | $274.77 | $130.52 | |
| levothyroxine sodium TAB 200MCG | Yes | Gap | $7.59 | $6.00 | |
| levothyroxine sodium TAB 25MCG | Yes | Gap | $5.01 | $3.96 | |
| Nexium CAP 40MG | Yes | Gap | $229.54 | $109.03 | |
| What you’ll spend in December: | $290.51 | ||||
| Total Estimated Annual Cost for 2013: | $6,202.92 | ||||
1 This number includes the amount you pay for drug copays and drug plan premiums, but not any health coverage premiums your plan may charge.
Your overall annual out-of-pocket cost is based on:
- Your premium: What you pay each month to your plan for coverage.
- The amount of your plan's annual deductible (the full cost you pay for your drugs before coverage kicks in) if your plan has one.
- What you pay toward the cost of your drugs in the initial coverage period. You pay either a copayment (a fixed-dollar amount) or coinsurance (a percentage of the drug's full cost) for each prescription. Your plan pays the rest.
- Any payments you make for your drugs during the coverage gap (or "doughnut hole"), when you pay the full price that your plan has negotiated with the manufacturers.
- What you pay (no more than 5 percent of the drug's price) during the catastrophic coverage period (if your costs are high enough to reach the out-of-pocket limit that gets you out of the gap before the end of the year)
Except for your premiums, all the above expenses count toward your out-of-pocket limit for the year. On January 1 of each year, you start counting expenses again.
Your Drug List
| Advair Diskus AER 250/50 1 AEPB per month Tier: 2
Quantity Limits
About this drug | Any options to save money? |
| levothyroxine sodium TAB 200MCG 30 TABS per month Tier: 1 About this drug | Any options to save money? |
| levothyroxine sodium TAB 25MCG 30 TABS per month Tier: 1 About this drug | Any options to save money? |
| Nexium CAP 40MG 30 CPDR per month Tier: 2
Quantity Limits
About this drug | Any options to save money? |
Your Pharmacy
These prices are approximate. They reflect the average of what you'd pay at any of your plan's in-network retail pharmacies. Actual costs vary slightly among these pharmacies. Mail-order costs, which are sometimes lower, are not shown. To select a specific pharmacy within your zip code, click here. The pharmacies you find may or may not be in-network. Please contact your plan directly to find out which pharmacies are in-network, including a mail-order pharmacy option.
My cost would be $3,265.74, or around $275 a month on average for the year. Drug cost inflation is rampant and may double in a handful of years.
ReplyDeleteCurrently I only paid $22.10 in Q1-Q3 2013 because Medicare Extra Help pays what my cost would be. My plan paid $1,685.80, and Medicare Extra Help paid $1,226.63. My total drug costs are $2,934.53. The gap sets in at "In 2013, once you reach $2,970 in prescription drug costs (which include both your share of covered drugs and the amount paid by your insurance,) you will be in the coverage gap. In 2013, you will get a 50 percent discount on brand-name drugs and a 14 percent discount on generic prescription drugs while you are in the coverage gap. When your total out-of-pocket costs reach $4,750, you qualify for "catastrophic coverage." At that point, you are responsible for only 5 percent of your prescription drug costs for the rest of the year. (If you receive "Extra Help" - a Medicare program to help people with limited income and resources pay Medicare prescription drug costs - you do not have a coverage gap. So the discount does not apply.)
ReplyDeleteExcept for your premiums, all the above expenses count toward your out-of-pocket limit for the year. On January 1 of each year, you start counting expenses again.
ReplyDeleteWhat IS the Doughnut Hole?
ReplyDeleteThe "doughnut hole" refers to a gap in prescription drug coverage under Medicare Part D. In 2013, once you reach $2,970 in prescription drug costs (which include both your share of covered drugs and the amount paid by your insurance,) you will be in the coverage gap. In 2013, you will get a 50 percent discount on brand-name drugs and a 14 percent discount on generic prescription drugs while you are in the coverage gap. When your total out-of-pocket costs reach $4,750, you qualify for "catastrophic coverage." At that point, you are responsible for only 5 percent of your prescription drug costs for the rest of the year.
(If you receive "Extra Help" - a Medicare program to help people with limited income and resources pay Medicare prescription drug costs - you do not have a coverage gap. So the discount does not apply.)
Because of the Affordable Health Care Act of 2010, the doughnut hole will gradually narrow until it disappears in 2020. Please see the Health Law Guide to find out more about the health law and how it benefits you.
If you want to see whether you are eligible for the Medicare Extra Help Program, check out Benefits Quicklink.
To share your experiences with the doughnut hole calculator and ask questions, visit the Medicare Part D online community group.
Find out more about how the new health care law helps people who fall into the doughnut hole this year by checking out this fact sheet.
Learn more about the doughnut hole at this AARP Bulletin guide on Medicare Prescription Drug Coverage.
http://doughnuthole.aarp.org/Default.aspx