Tips to Delay Reaching the Coverage Gap

Compare the following charts to see how using generic prescriptions and over the counter (OTC) medications delay reaching the Coverage Gap. Zhang used brand name medications only, while Merideth used Generic and OTC medication when available.

Now, let's take a look at the examples...

Zhang Example: Brand Medication Cost
Medication	Initial Coverage per Month		What counts toward the Coverage Gap
	Member pays	RxAmerica pays
Zocor tablet 40 mg 30 day supply	$40	$105.20	$40 + $105.20 = $145.20
Zoloft tablet 100 mg 30 day supply	$40	$45.19	$40 + $45.19 = $85.19
Nexium capsule 40mg 30 day supply	$20	$120.12	$20 + $120.12 = $140.12
Monthly total	$100	$270.51	$100 + $270.51 = $370.51

$370.51 per month X 12 months = $4446.12 (Zhang reaches the Coverage Gap in month 7)

After meeting the deductible in month 1, in month 2 Zhang would spend $100 out of pocket, but $370.51 would be applied toward the Coverage Gap. At this rate Zhang would reach the coverage gap in month 7.

Merideth Example: Generic and OTC Medication Cost
Medication	Initial Coverage per Month		What counts toward the Coverage Gap
	Member pays	RxAmerica pays
Simivastatin tablet 40mg 30 day supply (generic for Zocor)	$5	$7.23	$5 + $7.23 = $12.23
Sertraline hcl tablet 100mg 30 day supply (generic for Zoloft)	$5	$57.20	$5 + $57.20 = $62.20
Prilosec OTC 30 day supply	$0	$20	$0*
Monthly total	$10	$84.43	$12.23 + $62.20 = $74.43

$74.43 per month X 12 monthes = $893.16 (Merideth does not reach the Coverage Gap)

If you are currently using brand name medications, remember to talk to your doctor about generic and OTC medications. Your doctor can help you decide if they are appropriate for you.

*Note: RxAmerica offers OTC medications as part of our Step Therapy (STC) program. The cost OTC medications do not count toward the Coverage Gap or TrOOP.