- SPDAP will pay up to $35.00 per month for a member’s Medicare Rx prescription drug plan premium, as long as the individual is enrolled in an approved Medicare prescription drug plan or a Medicare Advantage prescription drug plan. There are 56 different prescription benefit plans and Medicare Advantage drug plan options from which to choose. A complete list of Stand Alone Plans may be found here. Follow this link for a complete list of Medicare Advantage Plans.
Coverage Gap (Doughnut Hole) Subsidy
The SPDAP will pay 95% of the entire drug costs for members while in the Coverage Gap, if enrolled in a plan that has agreed to offer the coverage gap subsidy. Members will only be responsible for a 5% co-insurance plus the non-formulary drug cost. If you are taking a brand name drug for which there is a 52.5% discount, your 5% co-insurance will be applied after the discount. If you are taking a generic drug for which your plan has applied a reduction, your 5% co-insurance will be applied after that reduction.