Navigating Part D

Breaking Down Medicare Part D

Your Medicare Part D patients can be confused by the various cost-sharing arrangements that are part of the Part D benefit.

To help you and your patients better understand Medicare Part D coverage for ZYDELIG^®, our Part D Coverage resource lets you estimate the breakdown of what Medicare pays and what your patients' out-of-pocket costs may be.
The resource only shows costs related to your patients' ZYDELIG prescription. Patients' out-of-pocket costs will vary based on other medicines that may be covered by their Medicare Part D benefit.
To estimate your patients' out-of-pocket costs, start by selecting one of the four coverage phases in the resource below and then proceed down, step by step. Learn more about Medicare Part D rights at Medicare.gov.

Your patients may need financial assistance during some of these coverage phases to help with out-of-pocket expenses. Learn more about alternative financial support that may be able to help.

Estimated 2018 Part D Standard Benefit Plan

Hypothetical Example: No Assistance

Select a coverage phase and
then proceed step by step:

Proceed by selecting
the next coverage phase.

Standard
Part D Plan

True Out-Of-
Pocket (TrOOP)

Medication Cost Summary

Patient pays: $405

Medication Cost Summary

When standard plan costs are between $405 and $3,750, Medicare may cover 75% of drug costs. The patient coinsurance is 25% in this phase. The patient coinsurance equals up to $836.25 in the initial coverage phase.

Medication Cost Summary

2018 Medicare Part D Discounts
Costs of plan-covered drugs are shared:

The patient pays 35%, plus 45% of the pharmacy dispensing fee (approximately $1 to $3)
Medicare Part D pays 15% of drug costs
The drug manufacturer provides 50% discount on drug costs

True Out-of-Pocket (TrOOP) costs:
The total amount spent in the donut hole (up to $3,758.75) includes:

The drug costs paid by the patient, and
The 50% discount on the drug cost

Payments made by the plan during the donut hole (15%) do not count toward TrOOP.

Medication Cost Summary

Once a patient emerges from the donut hole, their coinsurance is reduced to 5% or $8.35 (whichever is greater) of drug costs through the rest of the calendar year.

*Actual costs may vary.

Financial Support

Learn about financial programs that may help make ZYDELIG more affordable for patients.

See Programs

Adherence Support

Get tips to help your patients take their medication as prescribed.

View Services