Medicare Plan D Calculator

"30 Days Qty" is the amount of drug needed for one month's supply based on daily dose;
"$Avg Retail" is a U.S. pharmacy's average retail price for a 30 day (one month) supply;
"$US Network" is the benefit's discounted network price for a 30 day supply;
"90 Days Qty" is the amount of drug needed for a 90 day (three month) supply;
"$US Network" is the benefit's discounted network price for a 90 day supply;
"$World Option" is the price for a 90 day supply if obtained from the lowest-cost source in the "world" network, which includes international pharmacies and the U.S. network.

Each "$" column is then totaled to display the projected price for a year's utilization.

Why do some drugs display the same 90-day quantity prices in both the "US network" and "World Option" columns?

This happens when the drug is either not available from international sources or if it is less costly in the U.S. retail pharmacy network - example: generic drugs. (Remember - "World Option" includes the U.S. network, and the drug remains a component of your total market basket cost, so it appears in both columns.)

Are these prices guaranteed?

Prices displayed are "current prices". They are subject to increases or decreases that are determined by regular price updates.

If I enter the brand name for a drug that is generically available, what price will display?

The price shown will be the plan's allowed price for the generic alternative.

I am only taking a drug for a few weeks - Is its price included in the annual total(s)?

Yes, but you can adjust your estimated total annual cost appropriately by subtracting eleven times this particular drug's cost from the annual total.

What if my drug is a compounded drug?

You must get these in the U.S. network.

Why do some of my drugs not appear in the 90-day columns?

These are either drugs that your funded benefit plan limits to supplies for 30 days or less or drugs that are for short-term therapies (Antibiotics, etc.)

Does my benefit plan allow me to use the "World Option"?

All Discount Card Plan members can access the "World Option". For Funded Benefits, it is plan-specific.

Will there be any other costs if I choose to access prescriptions in the "World Option"? If so, what?

Discount Card Plan members may be required to pay postage and handling for each shipping package. Funded Benefit members' costs are determined by plan parameters.

Do I have to get my drugs through the lowest priced source in the "World Option"?

Plan members have the option to dictate prescription sourcing at their discretion.

How does the "World Option" save me money if my Funded Benefit Plan has a:

benefit deductible: member will pay less for drugs during the deductible.
benefit cap: member will pay less for drugs after capping out of the funded portion.
percentage-factored or add-on copay? Percentage copays will be based on lower cost drugs, and member costs for percentage add-on's will be reduced.

My funded benefit plan has fixed, flat copays - why should I care about using the cheapest source?

If your benefit is capped, your in-benefit period will be extended, and your saving money for your benefit plan allows your Sponsor to continue providing the best benefit possible.

What does (*) mean when it follows the name of a drug?

This is to indicate that the category in which that drug is included is not generally covered by Medicare, in which case you will have to pay the entire cost of a prescription for that drug.

What do the headings on the "Medicare Cost Analysis" mean and what does this analysis tell me?

This cost analysis projects the amount you will spend with prototype Medicare Card when all costs are considered as compared to the amount you would spend when using this non-Medicare discount card.

"Drugs Not Covered By Medicare" - This shows your out-of-pocket cost for drugs that Medicare will not pay for.
"Medicare Premium" - This is the annual amount that you must contribute to participate based on Medicare's prototype program. (This amount may vary from plan to plan; however you should be aware that this and other costs may be manipulated by any Medicare-approved plan. For example: A lower premium may be accompanied by higher copays and/or higher drug costs, etc.)
"Deductible" - This is the amount you must pay for covered drugs before your Medicare benefit will contribute anything.
"Level 1 Copay" - This is your portion of the cost that you must pay toward the cost of Medicare covered drugs after your deductible has been met and before you reach the non-funded "Donut Hole".
"Donut Hole" - This is the amount you must may after you exceed the first portion of your benefit - the amount of prescriptions' cost between $250 and $2250. This amount can be as much as $2850.
"Level 2 Copay" - This is your portion of the cost that you must pay for Medicare covered drugs after exceeding the "Donut Hole".
"Total Medicare Cost " - This is your projected total out-of-pocket expenditure for one year for these drugs when applying Medicare's prototype values and average U.S. Pharmacy prices.
"Total World Option Costs" - This is your projected total out-of-pocket expenditure for one year when you use this discount card to your maxium advantage by optaining these drugs from the least expensive source - the U.S. Retail Network and/or the International Providers.
"World Option Savings" - This is the amount you can save using this discount card. If this is a negative number, then the Medicare Benefit will save you more money.

Why does the Medicare Calculator reference "Average U.S. Retail" prices?

These average prices are based on the "usual and customary" prices for millions of pres

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