§1860D-3. Access to a choice of qualified prescription drug coverage

Social Security Act

Title XVIII — Health Insurance for the Aged and Disabled

Part D — Voluntary Prescription Drug Benefit Program³⁹⁴

Subpart 1 — Eligible Individuals and Prescription Drug Benefits

(42 U.S.C. 1395w-103)

(a) Assuring access to a choice of coverage.-

(a)(1) Choice of at least two plans in each area.- The Secretary shall ensure that each part D eligible individual has available, consistent with paragraph (2), a choice of enrollment in at least 2 qualifying plans (as defined in paragraph (3)) in the area in which the individual resides, at least one of which is a prescription drug plan. In any such case in which such plans are not available, the part D eligible individual shall be given the opportunity to enroll in a fallback prescription drug plan.

(a)(2) Requirement for different plan sponsors.- The requirement in paragraph (1) is not satisfied with respect to an area if only one entity offers all the qualifying plans in the area.

(a)(3) Qualifying plan defined.- For purposes of this section, the term "qualifying plan" means-

(a)(3)(A) a prescription drug plan; or

(a)(3)(B) an MA-PD plan described in section 1851(a)(2)(A)(i) that provides-

(a)(3)(B)(i) basic prescription drug coverage; or

(a)(3)(B)(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 1854(b)(1)(C).

(b) Flexibility in risk assumed and application of fallback plan.- In order to ensure access pursuant to subsection (a) in an area-

(b)(1) the Secretary may approve limited risk plans under section 1860D-11(f) for the area; and

(b)(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 1860D-11(g).