Sec. 127. Permanently authorize a successful pilot on retroactive Medicare part D coverage for low-income beneficiaries
543 words·~2 min read·
/bill/116/s/2543/rs/section-127·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Section 1860D–14 of the Social Security Act ( 42 U.S.C. 1395w–114 ) is amended— by redesignating subsection
(e)as subsection (f); and by inserting after subsection
(d)the following new subsection: By not later than 2022, the Secretary shall establish a program to provide transitional coverage for covered part D drugs for LI NET eligible individuals in accordance with this subsection. For purposes of this subsection, the term LI NET eligible individual means a part D eligible individual who— meets the requirements of clauses
(ii)and
(iii)of subsection (a)(3)(A); and has not yet enrolled in a prescription drug plan or an MA-PD plan, or, who has so enrolled, but with respect to whom coverage under such plan has not yet taken effect. For purposes of this subsection, the term transitional coverage means the following with respect to a LI NET eligible individual: Immediate access to covered part D drugs at the point of sale during the period that begins on the first day of the month such individual is determined to meet the requirements of clauses
(ii)and
(iii)of subsection (a)(3)(A) and ends on the date that coverage under a prescription drug plan or an MA–PD plan takes effect with respect to such individual. In the case of a LI NET eligible individual who is a full-benefit dual eligible individual (as defined in section 1935(c)(6)) or recipient of supplemental security income benefits under title XVI, retroactive coverage (in the form of reimbursement of the amounts that would have been paid under this part had such individual been enrolled in a prescription drug plan or an MA–PD plan) of covered part D drugs purchased by such individual during the period that— begins on the date that is the later of the date that— such individual was first eligible for a low income subsidy under this part; or is 36 months prior to the date such individual enrolls in a prescription drug plan or an MA–PD plan; and ends on the date that coverage under such plan takes effect. The Secretary shall, to the extent feasible, administer the program under this subsection through a contract with a single program administrator who will provide for a single point of contact for LI NET eligible individuals. The Secretary shall ensure that the transitional coverage provided to LI NET eligible individuals under this subsection— provides access to all covered part D drugs under an open formulary; permits all pharmacies determined by the Secretary to be in good standing to process claims under the program; is consistent with such requirements as the Secretary considers necessary to improve patient safety and ensure appropriate dispensing of medication; and meets such other requirements as the Secretary may establish. The following provisions shall not apply to the program under this subsection: Paragraphs
(1)and (3)(B) of section 1860D–4(a) (dissemination of general information; availability of information on changes in formulary through the internet). Subparagraphs
(A)and
(B)of section 1860D–4(b)(3) (development and revision by a pharmacy and therapeutic committee; formulary development). Paragraphs (1)(C) and
(2)of section 1860D–4(c) (medication therapy management program). The Secretary may waive such other requirements of title XI and this title as may be necessary to carry out the purposes of the program established under this subsection. .
Connections1 off-index
1 reference not yet in our index
- 42 USC 1395w–114
Citation graph
cites case law
Sec. 127
Permanently authorize a successful pilot on retroactive Medicare part D coverage for low-income beneficiaries
Cite42 USC 1395w–114
Cites 1Cited by 0 across 0 sources