The coverage gap, also known as the "donut hole":

After you and your plan have spent a certain amount on prescription drugs, you may enter a coverage gap where you are responsible for paying a larger share of the cost of your medications.

Prior authorization requirements:

Your plan may require prior authorization for certain medications, which can be time-consuming and may delay access to your medications.

Quantity limits:

Your plan may limit the amount of medication you can receive at one time, which can be inconvenient if you require frequent refills.

Non-covered medications:

Your plan may not cover certain medications, or may only cover them under certain conditions, such as if they are prescribed for a certain medical condition.

Tiered formularies:

Your plan may use a tiered formulary, where medications are grouped into different tiers based on their cost, with lower-cost medications being placed on lower tiers. This can mean higher out-of-pocket costs for medications on higher tiers.