There are four “drug payment stages” for your prescription drug coverage:

1. the Yearly Deductible stage
2. the Initial Coverage stage
3. the Coverage Gap stage
4. the Catastrophic Coverage stage

How much you pay depends on what stage you’re in when you get a prescription filled or refilled. You stay in the Initial Coverage stage until the total amount for the prescription drugs you’ve filled reaches the initial coverage limit for the year set by Medicare ($4,660 for 2023).

Once you go over this amount, you’ll enter the Coverage Gap stage.

During the Coverage Gap stage, you’ll pay 25% of the cost for both generic and brand-name drugs.

You continue paying these costs until your yearly out-of-pocket payments reach the maximum amount Medicare has set. Once you reach this amount ($7,400 for 2023), you leave the Coverage Gap stage and move to the Catastrophic Coverage stage.

The amount you pay in the Coverage Gap may vary depending on whether you have extra help, or your plan offers gap coverage for certain medications. Please refer to your Explanation of Coverage for further details.

Your drug’s manufacturer may sponsor a patient assistance program (PAP) that offers financial support to low-income individuals. This can help pay for medication costs your health plan does not cover. Each PAP requires an application to verify your income and determine if you meet any remaining requirements.

The help you receive through PAPs does not count towards the true-out-of-pocket (TrOOP) cost that will move you through the different payment stages.

The requirements for PAPs will vary and depend on your drug’s manufacturer. Requirements are listed in each application. Most PAPs require your doctor to fill out a portion of the application and include their signature.

Look on the specific drug manufacturer’s website, or use online tools to search for and locate PAPs. One tool we recommend is Needymeds.org:

• In the drug search bar, type in the name of your medication.
• Click on the link with your drug’s name.
• Select the icon for patient assistance programs (image of 2 capsules).
• Select the program application and form that applies.

The SCAN Rx Savings Finder Tool lets you search for pharmacy coupons to find the biggest savings for your medication.

Note: If you choose to purchase your medication using a third-party prescription discount coupon found in the SCAN Rx Savings Finder Tool, your SCAN health insurance will not be billed and the amount you pay will not count toward any deductible or other out-of-pocket costs.

How to find discount pharmacy coupons:

1. Start by going to the SCAN Rx Savings Finder Tool: scanhealthplanrxsavings.com
2. Enter your location or zip code in the SCAN Rx Savings Finder Tool to find the most accurate pricing near you.
3. Type the name of your medication into the search bar and select the appropriate form, dosage, and quantity that matches your prescription.
4. The tool will show a list of pharmacies near you and the lowest price available for your prescription medicine.
5. Choose the pharmacy where you’d like to pick up your medication, and the tool will display the coupon you’ll need to show the pharmacist at the counter.
6. Print, email, text, or show the pharmacist the coupon on your phone.
7. Don’t forget! When you’re at the pharmacy, ask the pharmacist to use your SCAN member ID when they enter the coupon information.

There may be other organizations or foundations that offer copay assistance based on your condition or treatment. Ask your doctor or pharmacy if they know of any they can connect you with. Some of these programs are listed on Needymeds.org.

Another resource for certain generic medications is Mark Cuban Cost Plus Drug Company, where you can compare costs for your generic medications.

No. SCAN is a Medicare Advantage plan. And, under federal law, manufacturer discount cards and programs can’t be applied to government-sponsored insurances such as Medicare.