COORDINATION REQUIREMENTS FOR PLANS PROVIDING PRESCRIPTION DRUG COVERAGE

Sec. 1860D-24. [42 U.S.C. 1395w-134] (a) Application of Benefit Coordination Requirements To Additional Plans.—

(1) In general.—The Secretary shall apply the coordination requirements established under section 1860D-23(a) 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.—To the extent specified by the Secretary, the requirements referred to in paragraph (1) shall apply to procedures established under section 1860D-2(b)(4)(D).

(3) User fees.—

(A) In general.—The Secretary may impose user fees for the transmittal of information necessary for benefit coordination under section 1860D-2(b)(4)(D) in a manner similar to the manner in which user fees are imposed under section 1842(h)(3)(B), except that the Secretary may retain a portion of such fees to defray the Secretary’s costs in carrying out procedures under section 1860D-2(b)(4)(D).

(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.—A State plan under title XIX, including such a plan operating under a waiver under section 1115, if it meets the requirements of section 1860D-23(b)(2).

(2) Group health plans.—An employer group health plan.

(3) FEHBP.—The Federal employees health benefits plan under chapter 89 of title 5, United States Code.

(4) Military coverage (including tricare).—Coverage under chapter 55 of title 10, United States Code.

(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) No affect on treatment of certain out-of-pocket expenditures.—The requirements of this section shall not affect the application of the procedures established under section 1860D-2(b)(4)(D).