Sec. 135. Growth rate of Medicare part D out-of-pocket cost threshold

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Section 1860D–2(b)(4) of the Social Security Act ( 42 U.S.C. 1395w–102(b)(4) ) is amended by adding at the end the following new subparagraph: Subject to clause (iv), the Secretary shall provide for payment from the Medicare Prescription Drug Account as follows: In the case of a specified individual (as defined in clause (ii)(I)) who as of the last day of a calendar quarter in 2020 has incurred costs for covered part D drugs so that the individual has exceeded the annual out-of-pocket threshold applied under subparagraph (B)(i)(V) for 2020, payment to the individual by not later than 15th day of the third month following the end of such quarter of the amount by which such threshold so applied exceeded the target threshold for 2020.

In the case of a specified individual who is not described in subclause

(I)and who as of the last day of 2020 has incurred costs for covered part D drugs so that the individual has exceeded the target threshold for 2020, payment to the individual by not later than December 31, 2021, of the amount by which such incurred costs exceeded the target threshold for 2020. For purposes of this subparagraph: The term specified individual means an individual who— is enrolled in a prescription drug plan or an MA– PD plan; is not enrolled in a qualified retiree prescription drug plan; and is not entitled to an income-related subsidy under section 1860D–14(a). the term target threshold for 2020 means the annual out-of-pocket threshold that would have been applied under subparagraph (B)(i) for 2020 if such threshold had been determined in accordance with subclause

(IV)of such subparagraph instead of subclause

(V)of such subparagraph. In the case of any specified individual who during 2020 has incurred costs for covered part D drugs so that the individual has exceeded the target threshold for 2020, the Secretary shall, not later than September 30, 2021, provide to such individual a notification informing such individual of such individual’s right to a payment described in clause

(i)and the estimated timing of such payment. The Secretary shall provide only 1 payment under this subparagraph with respect to any individual. The Secretary may implement this subparagraph by program instruction or otherwise. . Section 1860D–2(b)(4)(B)(i) of the Social Security Act ( 42 U.S.C. 1395w–102(b)(4)(B)(i) ) is amended— in subclause (V), by striking at the end or ; by redesignating subclause

(VI)as subclause (VIII); and by inserting after subclause

(V)the following new subclauses: for 2021, is equal to the amount that would have been applied under this subparagraph for 2020 if such amount had been determined in accordance with subclause

(IV)instead of subclause (V), increased by the lesser of— the annual percentage increase described in paragraph

(7)for 2021, plus 2 percentage points; or the annual percentage increase described in paragraph

(6)for 2021; for 2022, is equal to the amount that would have been applied under this subparagraph for 2022 if the amendments made by section 1101(d)(1) of the Health Care and Education Reconciliation Act of 2010 and by section 135 of the Lower Costs, More Cures Act of 2019 had not been enacted; or .

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42 USC 1395w–102(b)(4)
42 USC 1395w–102(b)(4)(B)(i)

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Sec. 135

Growth rate of Medicare part D out-of-pocket cost threshold

Cite42 USC 1395w–102(b)(4)

Cite42 USC 1395w–102(b)(4)(B)(i)

Cites 2Cited by 0 across 0 sources