What’s the Donut Hole?: Everything You Need to Know About Prescription Drug Coverage for Canadian Drugs

Category: Drug Information


Posted on July 3, 2019

Vanessa is a health writer and blogging expert. Her specialities are medicine, health and wellness. She is proud to call Vancouver, BC her home where she enjoys the ocean and mountains with her dog Mr. ChowChow.

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In 2018, 30.4 million Americans reported that they had no health insurance coverage. Are you caught in the Medicare Donut Hole? Do you need prescription medications but have no coverage? Canadian drugs can be your solution for prescription savings.

Some people are choosing to look outside the country to get their prescription medications. Many are looking north to obtain Canada drugs.

What Does Donut Hole Mean In Relation to Prescription Medications?

Most insurance plans that include Medicare Prescription Drug Coverage (Part D) have a gap in their coverage called the “donut hole”. When you and the drug plan have paid a certain amount of money for covered medications, you are responsible for the full out-of-pocket charges.

You then must pay for your medications until you reach a yearly limit. After that point, your drug plan resumes helping you pay for the medications.

Before you reach the donut hole, you pay 25% of your drug cost. Before the Affordable Care Act (ACA), you paid 100% while in the donut hole. With the ACA, the amount you pay while in the donut hole has decreased every year.

In 2019, the donut hole will go into effects when the amount you and your drug plan pay reaches $3,820. While in the hole, you will pay 37% for generic drugs and 25% for name-brand drugs.

By 2020, the donut hole will be eliminated. Enrollees with a standard plan will pay 25% of generic drug costs until they reach the catastrophic level. The 2019 catastrophic level is $5,100 including the deductible.

Is It Legal to Buy Canadian Drugs When You Live in the U.S?

The most direct answer to this question is no.

The Prescription Drug Marketing Act of 1987 defines the purchase and import of prescription drugs into the U.S. by anyone other than the original manufacturer illegal. Over time, federal officials have chosen to exercise “enforcement discretions”. This means they allow people to only bring 90-days of non-narcotic medications for personal use into the U.S.

What about online orders? If the order follows the same three-month supply, non-narcotic rule, there is no interference.

Restrictions placed on Canadian Pharmacies

You may not order more than a 90-day supply of medication based on a verified prescription order. This must only be for personal use. They aren’t able to fill any prescriptions for narcotics or controlled substances.

Cautions Regarding Internet Prescriptions

While it may seem easy to buy prescription drugs from Canada through the internet, there could be some hidden dangers. How do you know where the medication was actually manufactured?

The National Association of Boards of Pharmacy looked at more than 8,300 online pharmacies in July 2011. They found that only about 3 percent of the pharmacies met minimum standards.

Some companies marketed themselves as Canadian drug companies when their drugs were from all over the world. Some of these drugs were even counterfeit.

Remember that drug standards and regulations vary by country. The Food and Drug Administration (FDA) voices these concerns about foreign drugs:

Quality assurance

FDA rules only apply in the U.S. They may not follow the same quality assurance standards in other countries.

Counterfeit potential

You have no way to ensure that you get what you order. What you receive may be less effective or contain unsafe ingredients for you.

Presence of untested substances

Some ingredients are legal in other countries, but not in the U.S. This may cause you to take unexpected substances.

Taking medications without supervision

You should always take prescription medications under the supervision of a healthcare provider. This problem is usually monitored by the prescriber so that you are not given a refill without having a clinic visit.

Labeling and language issues

The country you buy the medication from may have different labeling standards. These may be difficult to understand or make claims not allowed in the U.S.

You may also not have information about serious side effects on the label. Thus, you may fail to promptly treat a serious symptom.

Learn More About Foreign Pharmacies and Canadian Drugs

Visit the following web sites to check the legitimacy of your online pharmacy:

  • Pharmacy Checker, which includes many online pharmacies including Canadian
  • FDA: Food and Drug Administration

Always take extra time to ensure that you are receiving quality medications. You do not want to take risks with your health.

Does My U.S. Health Insurance Cover Canadian Drugs?

Canadian drug companies can’t accept U.S. insurance plans to cover the cost of medications. You will receive a receipt that you can submit the receipt to your insurance company and see if they will reimburse your payment, though.

Do Medications from Canada Cost Less Than in the U.S.?

Canada controls drug prices. This often results from their national and universal healthcare. The government can negotiate medication costs and keep them low.

However, these price controls only apply to drugs sold and distributed in the Canadian territories. No price controls exist in the U.S. marketplace. Manufacturers can charge U.S. customers for research, development, and advertising costs.

Be sure to consider shipping costs when placing an order.

Are you Ready to Explore Different Options for Your Prescription Needs with Canadian Drugs?

We want to make sure that no one makes the choice between buying groceries and prescription medications. We can help you gain access to Canadian drugs.

Learn more about how to get online prescriptions filled and the rules and guidelines followed. Explore our site and find out how to order Canada drugs on our website today.

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