2024 Evidence of Coverage for UnitedHealthcare® Group Medicare Advantage PEBB Balance (PPO) Chapter 6: What you pay for your Part D prescription drugs 170 Section 5.3 If your doctor prescribes less than a full month’s supply, you may not have to pay the cost of the entire month’s supply Typically, the amount you pay for a prescription drug covers a full month’s supply. There may be times when you or your doctor would like you to have less than a month’s supply of a drug (for example, when you are trying a medication for the first time). You can also ask your doctor to prescribe, and your pharmacist to dispense, less than a full month’s supply of your drugs, if this will help you better plan refill dates for different prescriptions. If you receive less than a full month’s supply of certain drugs, you will not have to pay for the full month’s supply. · If you are responsible for coinsurance, you pay a percentage of the total cost of the drug. Since the coinsurance is based on the total cost of the drug, your cost will be lower since the total cost for the drug will be lower. · If you are responsible for a copayment for the drug, you will only pay for the number of days of the drug that you receive instead of a whole month. We will calculate the amount you pay per day for your drug (the “daily cost-sharing rate”) and multiply it by the number of days of the drug you receive. Section 5.4 You stay in the Initial Coverage Stage until your total drug costs for the year reach $5,030 You stay in the Initial Coverage Stage until the total amount for the prescription drugs you have filled reaches the $5,030 limit for the Initial Coverage Stage. The Part D EOB that you receive will help you keep track of how much you, the plan, and any third parties, have spent on your behalf for your drugs during the year. Many people do not reach the $5,030 limit in a year. We will let you know if you reach this amount. If you do reach this amount, you will leave the Initial Coverage Stage and move on to the Coverage Gap Stage. See Section 1.3 on how Medicare calculates your out-of-pocket costs. Section 6 Costs in the Coverage Gap Stage If you have any questions about the availability of discounts for the drugs you are taking or about the Medicare Coverage Gap Discount Program in general, please contact Customer Service (phone numbers are on the cover of this booklet). After you leave the Initial Coverage Stage, we will continue to pay our share of the cost of your drugs and you pay your share of the cost. You pay these amounts until your yearly out-of-pocket costs reach a maximum amount that Medicare has set. In 2024, that amount is $8,000. Medicare has rules about what counts and what does not count toward your out-of-pocket costs (Section 1.3). Coverage Gap Stage coinsurance requirements do not apply to Part D covered insulin products and most adult Part D vaccines.