I’m a pharmacy technician. Elderly patients come into us lately and sometimes the prescriptions they normally pay $0 for have copays upwards of $100+. Naturally they’re angry want to know why they have to pay so much. Now I learned what the donut hole is in my training but honestly never fully grasped it. I’ll sometimes have to get my pharmacist explain it to patients and while he’s doing it I can see their eyes glaze over after about 10 seconds. Can an insurance expert or pharmacist explain like I’m 5 what it is so I can explain to our patients what it is like they’re 5?
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Most plans with Medicare prescription drug coverage (Part D) have a coverage gap (called a “donut hole”). This means that after you and your drug plan have spent a certain amount of money for covered drugs, you have to pay all costs out-of-pocket for your prescriptions up to a yearly limit. Once you have spent up to the yearly limit, your coverage gap ends and your drug plan helps pay for covered drugs again.
That seems a little fucked
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