What percentage of most brand-name drugs does the member pay during the coverage gap?

During the coverage gap, also known as the "donut hole," members typically pay a percentage of the cost for brand-name drugs. As of legislation and guidelines established in the Affordable Care Act and subsequent updates, the member is responsible for 25% of the cost of most brand-name drugs during this phase of their Medicare Part D coverage.

This percentage reflects a key goal of Medicare prescription drug coverage reforms, which aimed to reduce out-of-pocket costs for patients during the coverage gap. The 25% payment allows members to share in the cost while attempting to make medications more affordable, reflecting the intent to alleviate the financial burden on patients who require ongoing medication.

Understanding this percentage is crucial for members managing their healthcare expenses, as it directly impacts budgeting for medical costs during the coverage gap period.