The Coverage Gap, also known as the “Donut Hole,” is part of the 4 official stages of Part D prescription coverage designed by the Center for Medicare and Medicaid Services (CMS).
Here are some ways to help manage drug costs before and during the Coverage Gap.
Tier 1 Generics—Many healthcare plans implement the use of a Tier 1 Generic category on their formulary. These medications are recognized by the Food and Drug Administration (FDA) as having the same active ingredient and strength as their associated higher-priced brand drug. Consult with your physician to see if a Tier 1 Generic would work best for you.
Mail Order Pharmacy—The old saying “the more you buy, the more you save” may come to mind. By using the Mail Order Services through OptumRx Home Delivery, you can save money versus using a retail pharmacy for your regular maintenance medications. Ask your physician to write for a 90 day supply for your regular maintenance medications. Keep in mind that pharmacies cannot dispense more than the quantity the prescriber wrote.
Preventive Drug List—In addition to a healthy lifestyle, preventive medications can help people avoid many illnesses and conditions. Preventive medications are defined as those prescribed to prevent the occurrence of a chronic disease or condition for individuals with risk factors, or to prevent the recurrence of a disease or condition. Some eligible medications include those for high blood pressure, high cholesterol, diabetes, asthma, osteoporosis, and heart disease.
To obtain prescription drugs by mail, use the following mail-order form or call our Pharmacy Member Services at (866) 909-5170 (TTY 711), Monday - Thursday, 24 hours a day, 7 days a week, Fridays from 12:00 a.m. to 9:00 p.m. CST, Saturdays from 7:00 a.m. to 3:30 p.m. CST, and Sundays from 9:00 p.m. to 12 a.m. CST.
Prescription drugs that you get through any other mail order service are not covered.