42 USC 1395w-103 - Access to a choice of qualified prescription drug coverage

U.S Code last checked for updates: Feb 22, 2025

§ 1395w–103.

Access to a choice of qualified prescription drug coverage

(a)

Assuring access to a choice of coverage

(1)

Choice of at least two plans in each area

(2)

Requirement for different plan sponsors

(3)

Qualifying plan defined

For purposes of this section, the term “qualifying plan” means—

(A)

a prescription drug plan; or

(B)

an MA–PD plan described in section 1395w–21(a)(2)(A)(i) of this title that provides—

(i)

basic prescription drug coverage; or

(ii)

qualified prescription drug coverage that provides supplemental prescription drug coverage so long as there is no MA monthly supplemental beneficiary premium applied under the plan, due to the application of a credit against such premium of a rebate under section 1395w–24(b)(1)(C) of this title.

(b)

Flexibility in risk assumed and application of fallback plan

In order to ensure access pursuant to subsection (a) in an area—

(1)

the Secretary may approve limited risk plans under section 1395w–111(f) of this title for the area; and

(2)

only if such access is still not provided in the area after applying paragraph (1), the Secretary shall provide for the offering of a fallback prescription drug plan for that area under section 1395w–111(g) of this title.

(Aug. 14, 1935, ch. 531, title XVIII, § 1860D–3, as added Pub. L. 108–173, title I, § 101(a)(2), Dec. 8, 2003, 117 Stat. 2081.)

cite as: 42 USC 1395w-103