US Code

Public Law 119-102 (07/12/2026)

42 U.S.C. § 1395w–134

Coordination requirements for plans providing prescription drug coverage

Section text and notes

(a)

Application of benefit coordination requirements to additional plans

(1)

In general

section 1395w–133(a) of this titleThe Secretary shall apply the coordination requirements established under to Rx plans described in subsection (b) in the same manner as such requirements apply to a State Pharmaceutical Assistance Program.

(2)

Application to treatment of certain out-of-pocket expenditures

section 1395w–102(b)(4)(D) of this titleTo the extent specified by the Secretary, the requirements referred to in paragraph (1) shall apply to procedures established under .

(3)

User fees

(A)

In general

section 1395w–102(b)(4)(D) of this titlesection 1395u(h)(3)(B) of this titlesection 1395w–102(b)(4)(D) of this titleThe Secretary may impose user fees for the transmittal of information necessary for benefit coordination under in a manner similar to the manner in which user fees are imposed under , except that the Secretary may retain a portion of such fees to defray the Secretary’s costs in carrying out procedures under .

(B)

Application

A user fee may not be imposed under subparagraph (A) with respect to a State Pharmaceutical Assistance Program.

(b)

Rx Plan

An Rx plan described in this subsection is any of the following:
(1)

Medicaid programs

section 1315 of this titlesection 1395w–133(b)(2) of this titleA State plan under subchapter XIX, including such a plan operating under a waiver under , if it meets the requirements of .

(2)

Group health plans

An employer group health plan.

(3)

FEHBP

The Federal employees health benefits plan under chapter 89 of title 5.

(4)

Military coverage (including TRICARE)

Coverage under chapter 55 of title 10.

(5)

Other prescription drug coverage

Such other health benefit plans or programs that provide coverage or financial assistance for the purchase or provision of prescription drug coverage on behalf of part D eligible individuals as the Secretary may specify.

(c)

Relation to other provisions

(1)

Use of cost management tools

The requirements of this section shall not impair or prevent a PDP sponsor or MA organization from applying cost management tools (including differential payments) under all methods of operation.

(2)

1
1 So in original. Probably should be “effect”.
No affect  on treatment of certain out-of-pocket expenditures

section 1395w–102(b)(4)(D) of this titleThe requirements of this section shall not affect the application of the procedures established under .

Aug. 14, 1935, ch. 531 Pub. L. 108–173, title I, § 101(a)(2)117 Stat. 2130 (, title XVIII, § 1860D–24, as added , , .)