Get free help preparing your taxes from AARP Foundation Tax-Aide. Find a location


AARP Staying Sharp: Keep Your Brain Healthy
Bob Dylan Talks!


Military and Veterans Discount


You Could Choose Your Dream Vacation


Introducing RealPad by AARP


AARP Auto Buying Program


Piggy bank on the road - AARP Driver Safety

Take the new AARP Smart Driver Course!

Download the ipad App



AARP Games - Play Now!

AARP Books

Medicare for Dummies book cover

Get the answers you need, from Patricia Barry, AARP's Ask Ms. Medicare

Most Popular


share your Thoughts

Reader stories help us fine-tune our education efforts and strengthen our calls for action on issues that matter most to you. We read and learn from every story and may use yours (with permission) to brief legislators, inspire other readers and more. Please share your story with us. Do

Ask Ms. Medicare

Paying Less for Drugs in the Part D 'Doughnut Hole'

New money-saving changes are in place

My plan doesn't normally cover one of my drugs but agreed to cover it because it was medically necessary for me. Will I get a discount for this drug in the gap?

Yes. If a plan grants coverage for a drug that's not on its formulary — usually in response to the patient's doctor's request for an exception to its rules — this drug is considered a covered drug for the purpose of discounts in the doughnut hole and counts toward the dollar limit that gets you out of the gap. But no exceptions can be granted for a drug made by a manufacturer that does not participate in the discount program.

What if my plan already gives some coverage for my drugs in the gap?

Your plan's coverage is applied first, and the discounts are applied to the remaining amount.

Example: You are enrolled in an "enhanced" Part D plan that covers 40 percent of the cost of your drugs in the gap. You go to the pharmacy to fill a prescription for a brand-name drug that costs $100. The plan pays $40 of this amount, leaving $60 as your share. But after the manufacturer's discount is applied, you pay $28.50 plus a dispensing fee of, say, $2. The $40 that the plan paid does not count toward the spending limit that gets you out of the doughnut hole. But the rest — the whole $62 — does count.

What if I'm enrolled in a state pharmacy assistance program?

You still get the discounts in the doughnut hole. They will be applied to the price of your drugs before the state assistance kicks in. This is also true for other programs that provide help to pay for Part D drugs, except for Extra Help.

What if I already get assistance from a drug manufacturer?

You should check with the manufacturer's patient assistance program to see if its policy has changed.

How will I know if the proper discounts have been applied?

An explanation will be included in the regular statements you receive from your plan. If you have reason to think that you haven't received the correct discounts, call the number shown on your plan membership card. If you disagree with the plan's explanation, you can use the standard appeals process to resolve the issue. You can also call Medicare at 1-800-633-4227 to file a complaint.

Patricia Barry is a senior editor for AARP Integrated Media and the author of “Medicare For Dummies” (Wiley/AARP, October 2013).

Topic Alerts

You can get weekly email alerts on the topics below. Just click “Follow.”

Manage Alerts


Please wait...

progress bar, please wait

Tell Us WhatYou Think

Please leave your comment below.

Discounts & Benefits

From companies that meet the high standards of service and quality set by AARP.

Walgreens 1 discount membership aarp

Members get exclusive points offers from Walgreens, Duane Reade and

member benefit aarp hear usa

Members can save 20% on hearing aids with the AARP® Hearing Care Program provided by HearUSA.

AARP membership discount Man trying on eyeglasses at optometrists smiling

Members save up to 60% on eye exams and 30% on glasses at LensCrafters.

Member Benefits

Join or renew today! AARP members receive exclusive member benefits & affect social change.