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Avoid Paying A Part D Penalty

Even if you don’t take a lot of prescription drugs you should consider enrolling in a Medicare Part D plan at the time that you become eligible for Medicare.  If you don’t have other creditable Part D Coverage and choose not to enroll or have a lapse in Part D coverage for a period of 63 days or more you will be charged a late enrollment penalty. The cost of the penalty will be calculated at 1% per month above the standard base premium from the time of your eligibility to the time that you enroll in a Part D Plan. In most cases you will continue to pay this higher premium for as long as you have Medicare Part D.

Coverage Gap Discounts  (Donut Hole)

The Affordable Health Care Act provides discounts for drugs on formulary when you reach the coverage gap. You enter the coverage gap when your True Out Of Pocket (TROOP) costs reach a certain

amount. The amount of the discount for 2016 is 55% for brand name drugs and 42% for generic drugs. If your prescription drug is not on formulary you or your doctor should contact your prescription drug plan and request an exception.

Copayments and Coinsurance

The cost sharing for prescription drugs depends in part on the Tier of the drug. The higher the Tier the more a drug cost. You or your provider should contact the Prescription Drug Plan to request an exception if the drug is on a higher tier.

Preferred Pharmacy

The cost of your prescription drugs may be lower if filled at a pharmacy that participates with your drug plan. These are referred to as ‘network pharmacies’. Contact your prescription drug plan for the most up to date list of  ‘network pharmacies’.

Some prescription drugs may cost less if filled by mail order. Check with your prescription drug plan. Drug manufactures offer discounts for certain drugs. These discounts may have an income requirement. Check with the Drug Pharmaceutical Company to see if you may be eligible for a discount.

Extra Help

You may qualify for help in lowering your out of pocket costs for prescription drugs if your income is limited. To find out if you are eligible contact the following:


  • Social Security 1-800-772-1213
  • Your local Medicaid Office to apply for the Medicare Savings Program
  • NY State EPIC Program 1-800-332-3742
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