Medicare Plan Payment: Coverage Gap Discount Program
Guidance for Coverage Gap Discount Program.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: July 16, 2019
Since the Coverage Gap Discount Program began on January 1, 2011, CMS has been analyzing Prescription Drug Event (PDE) data to understand how many discounts have been provided in the coverage gap and for which classes of prescription drugs. We have created four documents illustrating our findings. Under "Downloads," the link titled "Coverage Gap Discount Data Spreadsheet" contains three documents. The first document shows the total number of beneficiaries (by state) receiving a gap discount, the total gap discount amount, the average gap discount amount by beneficiary, and the count of PDEs with a gap discount. The second document shows the year-to-date coverage gap discount data by zip code with the city name, county name, and state included. The third document shows the year-to-date coverage gap discount data by county code with the state and county names included. The final document "Total Coverage Gap Discount Amount by Drug Therapeutic Use" under "Downloads" is a pie chart showing the total coverage gap discount amount by drug therapeutic use.
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