Starting in January 2011, people with Medicare who have Part D but don’t have the low-income subsidy Extra Help will get a 50 percent discount under the Medicare Coverage Gap Discount Program on “applicable” drugs at the point of sale, and a 7 percent increase in coverage for all other covered Part D drugs (e.g., generic drugs and supplies associated with the delivery of insulin) while they are in the coverage gap.
Not all drug manufacturers are participating in the program; only those who have signed agreements with CMS to participate in the Medicare Coverage Gap Discount Program will offer the discounted prescriptions. If a drug manufacturer doesn’t sign a discount agreement with CMS, its applicable drugs won’t be covered under Part D, and Part D sponsors won’t be allowed to grant an exception or provide a transition for such drugs. People may still buy the drug at its full price, but the cost won’t count toward getting out of the coverage gap.
CMS has published a listing of companies that have signed an agreement along with the associated five-digit labeler codes on its website; the listing of labeler codes and manufacturers can be found on the CMS website, under “2011 Labeler Code File.”