42 U.S.C. § 1395w–151 | Definitions; treatment of references to…

(a)

Definitions

For purposes of this part:

(1)

Basic prescription drug coverage

section 1395w–102(a)(3) of this titleThe term “basic prescription drug coverage” is defined in .

(2)

Covered part D drug

section 1395w–102(e) of this titleThe term “covered part D drug” is defined in .

(3)

Creditable prescription drug coverage

section 1395w–113(b)(4) of this titleThe term “creditable prescription drug coverage” has the meaning given such term in .

(4)

Part D eligible individual

section 1395w–101(a)(3)(A) of this title1

1 See References in Text note below.

The term “part D eligible individual” has the meaning given such term in .

(5)

Fallback prescription drug plan

section 1395w–111(g)(4) of this titleThe term “fallback prescription drug plan” has the meaning given such term in .

(6)

Initial coverage limit

section 1395w–102(b)(3) of this titleThe term “initial coverage limit” means such limit as established under for a year before 2025, or, in the case of coverage that is not standard prescription drug coverage, the comparable limit (if any) established under the coverage for such year.

(7)

Insurance risk

The term “insurance risk” means, with respect to a participating pharmacy, risk of the type commonly assumed only by insurers licensed by a State and does not include payment variations designed to reflect performance-based measures of activities within the control of the pharmacy, such as formulary compliance and generic drug substitution.

(8)

MA plan

section 1395w–101(a)(3)(B) of this title¹The term “MA plan” has the meaning given such term in .

(9)

MA–PD plan

section 1395w–101(a)(3)(C) of this title¹The term “MA–PD plan” has the meaning given such term in .

(10)

Medicare Prescription Drug Account

section 1395w–116(a) of this titleThe term “Medicare Prescription Drug Account” means the Account created under .

(11)

PDP approved bid

section 1395w–113(a)(6) of this titleThe term “PDP approved bid” has the meaning given such term in .

(12)

PDP region

section 1395w–111(a)(2) of this titleThe term “PDP region” means such a region as provided under .

(13)

PDP sponsor

The term “PDP sponsor” means a nongovernmental entity that is certified under this part as meeting the requirements and standards of this part for such a sponsor.

(14)

Prescription drug plan

The term “prescription drug plan” means prescription drug coverage that is offered—

(A)

section 1395w–111(e) of this title under a policy, contract, or plan that has been approved under ; and

(B)

section 1395w–112(b) of this title by a PDP sponsor pursuant to, and in accordance with, a contract between the Secretary and the sponsor under .

(15)

Qualified prescription drug coverage

section 1395w–102(a)(1) of this titleThe term “qualified prescription drug coverage” is defined in .

(16)

Standard prescription drug coverage

section 1395w–102(b) of this titleThe term “standard prescription drug coverage” is defined in .

(17)

State Pharmaceutical Assistance Program

section 1395w–133(b) of this titleThe term “State Pharmaceutical Assistance Program” has the meaning given such term in .

(18)

Subsidy eligible individual

section 1395w–114(a)(3)(A) of this titleThe term “subsidy eligible individual” has the meaning given such term in .

(b)

Application of part C provisions under this part

For purposes of applying provisions of part C under this part with respect to a prescription drug plan and a PDP sponsor, unless otherwise provided in this part such provisions shall be applied as if—

(1)

any reference to an MA plan included a reference to a prescription drug plan;

(2)

any reference to an MA organization or a provider-sponsored organization included a reference to a PDP sponsor;

(3)

section 1395w–27 of this title section 1395w–112(b) of this title any reference to a contract under included a reference to a contract under ;

(4)

any reference to part C included a reference to this part; and

(5)

section 1395w–21 of this title section 1395w–101 of this title any reference to an election period under were a reference to an enrollment period under .

Aug. 14, 1935, ch. 531 Pub. L. 108–173, title I, § 101(a)(2)Dec. 8, 2003117 Stat. 2148 Pub. L. 117–169, title I, § 11201(e)(6)Aug. 16, 2022136 Stat. 1892 (, title XVIII, § 1860D–41, as added , , ; amended , , .)

Editorial Notes

References in Text

Section 1395w–101(a)(3) of this titleAug. 14, 1935section 1395w–101(a)(3) of this title section 1395w–101(a) of this title, referred to in subsec. (a)(4), (8), (9), was in the original “section 1860D–1(a)(4)”, and was translated as meaning section 1860D–1(a)(3) of act , which is classified to , to reflect the probable intent of Congress, because does not contain a par. (4) and par. (3) defines terms for purposes of this part.

Amendments

Pub. L. 117–1692022—Subsec. (a)(6). inserted “for a year before 2025” after “1395w–102(b)(3) of this title” and “for such year” before period at end.

Section text and notes