Deductible phase Expand Collapse
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.
Before Gap, or Initial Coverage Phase Expand Collapse
In this phase, you will either pay a copay or coinsurance (a percentage of the drug’s cost) when you have a prescription filled. This phase lasts until you and your plan reach a total of $4,430 in 2022 drug spending, at which time you move into the Coverage Gap phase.
During Gap, or Coverage Gap Phase Expand Collapse
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 $7,050 in 2022.
After Gap, or Catastrophic Coverage Phase Expand Collapse
After you reach a total of $7,050 in 2022 in out-of-pocket prescription drug expenses, you will start paying a different copay or coinsurance for both generic and brand-name prescription drugs. In the Catastrophic Coverage phase, copays are typically lower than during the Initial Coverage phase. This phase lasts until the end of the plan year.
