Several plans cover certain drug tiers immediately (usually lower tiers), before the patient reaches their deductible limit. This means that these drugs will be covered as if the patient is in the initial coverage phase, and the copays for these drugs will NOT count towards the deductible limit. 

This situation happens often and can easily be identified by comparing the patient's copays and full costs for each medication. If the patient is paying only a portion of the total drug cost even though the patient hasn't met the deductible limit, that drug is excluded from the deductible and will not be counted towards the deductible limit. 

If the patient fills at least one drug that is not excluded from the deductible, they will essentially be in the deductible phase until they reach the deductible limit and will be identified as such in Amplicare. However, if they only fill drugs that are on tiers exempt from the deductible for the entire year, they will essentially just “skip” the deductible entirely. When this happens, in Amplicare the patient will be listed as being in "Initial Coverage" and not the "Deductible". 

What's Next?

Learn more about the different Medicare phases of coverage here.

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