Sec. 134. Establishing a monthly cap on beneficiary incurred costs for insulin products and supplies under a prescription drug plan or MA–PD plan

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Section 1860D–2 of the Social Security Act ( 42 U.S.C. 1395w–102 ), as amended by sections 121 and 133, is further amended— in subsection (b)(2)— in subparagraph (A), by striking and

(E)and inserting (E), and

(F); in subparagraph (B), by striking and

(D)and inserting (D), and

(F); and by adding at the end the following new subparagraph: The coverage provides benefits, for costs above the annual deductible specified in paragraph

(1)and up to the annual out-of-pocket threshold described in paragraph (4)(B) and with respect to a month (beginning with January of 2022), with cost sharing that is equal to $0 for a specified covered part D drug (as defined in clause (iii)) furnished to an individual who has incurred costs during such month with respect to specified covered part D drugs equal to— for months occurring in 2022, $50; or for months occurring in a subsequent year, the amount applicable under this clause for months occurring in the year preceding such subsequent year, increased by the annual percentage increase specified in paragraph

(6)for such subsequent year and rounded to the nearest dollar. The provisions of clauses

(i)through

(iii)of paragraph (4)(C) shall apply with respect to the determination of the incurred costs for specified covered part D drugs for purposes of clause

(i)in the same manner as such provisions apply with respect to the determination of incurred costs for covered part D drugs for purposes of paragraph (4)(A). For purposes of this subparagraph, the term specified covered part D drug means a covered part D drug that is— insulin; or a medical supply associated with the injection of insulin (as defined in regulations of the Secretary promulgated pursuant to subsection (e)(1)(B)). ; and in subsection (c), by adding at the end the following new paragraph: The coverage provides the coverage required under subsection (b)(2)(F). . Section 1860D–14(a)(1)(D) of the Social Security Act ( 42 U.S.C. 1395w–114(a)(1)(D) ), as amended by section 121, is further amended— in clause (ii), by striking section 1860D–2(b)(2) and inserting section 1860D–2(b)(2)(A) ; and in clause (iii), by striking section 1860D–2(b)(2) and inserting section 1860D–2(b)(2)(A) . The amendments made by paragraph

(1)shall apply with respect to plan year 2022 and each subsequent plan year.

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42 USC 1395w–102
42 USC 1395w–114(a)(1)(D)

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Sec. 134

Establishing a monthly cap on beneficiary incurred costs for insulin products and supplies under a prescription drug plan or MA–PD plan

Cite42 USC 1395w–102

Cite42 USC 1395w–114(a)(1)(D)

Cites 2Cited by 0 across 0 sources