§1860D-41. Definitions; Treatment Of References To Provisions In Part C

Social Security Act

Title XVIII — Health Insurance for the Aged and Disabled

Part D — Voluntary Prescription Drug Benefit Program³⁹⁴

Subpart 5 — Definitions and Miscellaneous Provisions

(42 U.S.C. §1395w-151)

(a) Definitions. - For purposes of this part:

(a)(1) Basic Prescription Drug Coverage. - The term "basic prescription drug coverage" is defined in section 1860D-2(a )(3).

(a)(2) Covered Part D Drug. - The term "covered part D drug" is defined in section 1860D-2(e).

(a)(3) Creditable Prescription Drug Coverage. - The term "creditable prescription drug coverage" has the meaning given such term in section 1860D-13(b)(4).

(a)(4) Part D Eligible Individual. - The term "part D eligible individual" has the meaning given such term in section 1860D-1(a)(4)(A).

(a)(5) Fallback Prescription Drug Plan. - The term "fallback prescription drug plan" has the meaning given such term in section 1860D-11(g)(4).

(a)(6) Initial Coverage Limit. - The term "initial coverage limit" means such limit as established under section 1860D-2(b)(3), or, in the case of coverage that is not standard prescription drug coverage, the comparable limit (if any) established under the coverage.

(a)(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.

(a)(8) MA Plan. - The term "MA plan" has the meaning given such term in section 1860D-1(a)(4)(B).

(a)(9) MA-PD Plan. - The term "MA-PD plan" has the meaning given such term in section 1860D-1(a)(4)(C).

(a)(10) Medicare Prescription Drug Account. - The term "Medicare Prescription Drug Account" means the Account created under section 1860D-16(a).

(a)(11) PDP Approved Bid. - The term "PDP approved bid" has the meaning given such term in section 1860D-13(a)(6).

(a)(12) PDP Region. - The term "PDP region" means such a region as provided under section 1860D-11(a )(2).

(a)(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.

(a)(14) Prescription Drug Plan. - The term "prescription drug plan" means prescription drug coverage that is offered -

(a)(14)(A) under a policy, contract, or plan that has been approved under section 1860D-11(e); and

(a)(14)(B) by a PDP sponsor pursuant to, and in accordance with, a contract between the Secretary and the sponsor under section 1860D-12(b).

(a)(15) Qualified Prescription Drug Coverage. - The term "qualified prescription drug coverage" is defined in section 1860D-2(a )(1).

(a)(16) Standard Prescription Drug Coverage. - The term "standard prescription drug coverage" is defined in section 1860D-2(b).

(a)(17) State Pharmaceutical Assistance Program. - The term "State Pharmaceutical Assistance Program" has the meaning given such term in section 1860D-23(b).

(a)(18) Subsidy Eligible Individual. - The term "subsidy eligible individual" has the meaning given such term in section 1860D-14(a)(3)(A).

( 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 -

(b)(1) any reference to an MA plan included a reference to a prescription drug plan;

(b)(2) any reference to an MA organization or a provider-sponsored organization included a reference to a PDP sponsor;

(b)(3) any reference to a contract under section 1857 included a reference to a contract under section 1860D-12(b);

(b)(4) any reference to part C included a reference to this part; and

(b)(5) any reference to an election period under section 1851 were a reference to an enrollment period under section 1860D-1.