The first stage occurs at the beginning of your prescription drug coverage. This is the period when you pay for your prescription drugs in full (reduced by the plans low negotiated rates) until you meet your yearly deductible amount. After the deductible is met, you move into the Initial Coverage stage.
Some plans do not have a yearly deductible. Under these plans, you would begin in the Before Gap or Initial Coverage stage.
Often called the 'Initial Coverage Phase', you will pay the plan's copays or coinsurance until a total drug cost of $4,020 in 2020 is reached.
Often called the 'Donut Hole Phase', you will pay 25% of the plan's negotiated rate for a covered drug until your total out of pocket cost reaches $6,350 in 2020.
Often called the 'Catastrophic Phase’, you will likely have lower cost sharing through the end of the calendar year once you have reached $6,350 in 2020 in out of pocket drug costs. During this phase, you will pay $3.60 for Generic drugs and $8.95 for Brand drugs, or 5% coinsurance – whichever is greater.