Sec. 11201. Medicare part D benefit redesign

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A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

Section 1860D–2(b) of the Social Security Act ( 42 U.S.C. 1395w–102(b) ) is amended— in paragraph (2)— in subparagraph (A), in the matter preceding clause (i), by inserting for a year preceding 2025 and for costs above the annual deductible specified in paragraph

(1)and up to the annual out-of-pocket threshold specified in paragraph (4)(B) for 2025 and each subsequent year after paragraph

(3); in subparagraph (C)— in clause (i), in the matter preceding subclause (I), by inserting for a year preceding 2025, after paragraph (4), ; and in clause (ii)(III), by striking and each subsequent year and inserting through 2024 ; and in subparagraph (D)— in clause (i)— in the matter preceding subclause (I), by inserting for a year preceding 2025, after paragraph (4), ; and in subclause (I)(bb), by striking a year after 2018 and inserting each of years 2019 through 2024 ; and in clause (ii)(V), by striking 2019 and each subsequent year and inserting each of years 2019 through 2024 ; in paragraph (3)(A)— in the matter preceding clause (i), by inserting for a year preceding 2025, after and (4), ; and in clause (ii), by striking for a subsequent year and inserting for each of years 2007 through 2024 ; and in paragraph (4)— in subparagraph (A)— in clause (i)— by redesignating subclauses

(I)and

(II)as items

(aa)and (bb), respectively, and moving the margin of each such redesignated item 2 ems to the right; in the matter preceding item (aa), as redesignated by subclause (I), by striking is equal to the greater of— and inserting “is equal to— for a year preceding 2024, the greater of— ; by striking the period at the end of item (bb), as redesignated by subclause (I), and inserting ; and ; and by adding at the end the following: for 2024 and each succeeding year, $0. ; and in clause (ii)— by striking clause (i)(I) and inserting clause (i)(I)(aa) ; and by adding at the end the following new sentence: The Secretary shall continue to calculate the dollar amounts specified in clause (i)(I)(aa), including with the adjustment under this clause, after 2023 for purposes of section 1860D–14(a)(1)(D)(iii). ; in subparagraph (B)— in clause (i)— in subclause (V), by striking or at the end; in subclause (VI)— by striking for a subsequent year and inserting for each of years 2021 through 2024 ; and by striking the period at the end and inserting a semicolon; and by adding at the end the following new subclauses: for 2025, is equal to $2,000; or for a subsequent year, is equal to the amount specified in this subparagraph for the previous year, increased by the annual percentage increase described in paragraph

(6)for the year involved. ; and in clause (ii), by striking clause (i)(II) and inserting clause

(i); in subparagraph (C)— in clause (i), by striking and for amounts and inserting and, for a year preceding 2025, for amounts ; and in clause (iii)— by redesignating subclauses

(I)through

(IV)as items

(aa)through

(dd)and indenting appropriately; by striking if such costs are borne or paid and inserting “if such costs— are borne or paid— ; and in item (dd), by striking the period at the end and inserting ; or ; and by adding at the end the following new subclause: for 2025 and subsequent years, are reimbursed through insurance, a group health plan, or certain other third party payment arrangements, but not including the coverage provided by a prescription drug plan or an MA–PD plan that is basic prescription drug coverage (as defined in subsection (a)(3)) or any payments by a manufacturer under the manufacturer discount program under section 1860D–14C. ; and in subparagraph (E), by striking In applying and inserting For each of years 2011 through 2024, in applying . Section 1860D–15(b) of the Social Security Act ( 42 U.S.C. 1395w–115(b) ) is amended— in paragraph (1)— by striking equal to 80 percent and inserting “equal to— for a year preceding 2025, 80 percent ; in subparagraph (A), as added by subparagraph (A), by striking the period at the end and inserting ; and ; and by adding at the end the following new subparagraph: for 2025 and each subsequent year, the sum of— with respect to applicable drugs (as defined in section 1860D–14C(g)(2)), an amount equal to 20 percent of such allowable reinsurance costs attributable to that portion of gross covered prescription drug costs as specified in paragraph

(3)incurred in the coverage year after such individual has incurred costs that exceed the annual out-of-pocket threshold specified in section 1860D–2(b)(4)(B); and with respect to covered part D drugs that are not applicable drugs (as so defined), an amount equal to 40 percent of such allowable reinsurance costs attributable to that portion of gross covered prescription drug costs as specified in paragraph

(3)incurred in the coverage year after such individual has incurred costs that exceed the annual out-of-pocket threshold specified in section 1860D–2(b)(4)(B). ; in paragraph (2)— by striking and inserting COSTS .—For purposes Costs.— Subject to subparagraph (B), for purposes ; and by adding at the end the following new subparagraph: For purposes of applying subparagraph (A), the term ‘allowable reinsurance costs’ shall include the portion of the negotiated price (as defined in section 1860D–14C(g)(6)) of an applicable drug (as defined in section 1860D–14C(g)(2)) that was paid by a manufacturer under the manufacturer discount program under section 1860D–14C. ; and in paragraph (3)— in the first sentence, by striking For purposes and inserting Subject to paragraph (2)(B), for purposes ; and in the second sentence, by inserting (or, with respect to 2025 and subsequent years, in the case of an applicable drug, as defined in section 1860D–14C(g)(2), by a manufacturer) after by the individual or under the plan . Part D of title XVIII of the Social Security Act (42 U.S.C. 1395w–101 through 42 U.S.C. 1395w–153 ), as amended by section 11102, is amended by inserting after section 1860D–14B the following new sections: The Secretary shall establish a manufacturer discount program (in this section referred to as the program ). Under the program, the Secretary shall enter into agreements described in subsection

(b)with manufacturers and provide for the performance of the duties described in subsection (c). An agreement under this section shall require the manufacturer to provide, in accordance with this section, discounted prices for applicable drugs of the manufacturer that are dispensed to applicable beneficiaries on or after January 1, 2025. Nothing in this section shall be construed as affecting— the application of a coinsurance of 25 percent of the negotiated price, as applied under paragraph (2)(A) of section 1860D–2(b), for costs described in such paragraph; or the application of the copayment amount described in paragraph (4)(A) of such section, with respect to costs described in such paragraph. In order for an agreement with a manufacturer to be in effect under this section with respect to the period beginning on January 1, 2025, and ending on December 31, 2025, the manufacturer shall enter into such agreement not later than March 1, 2024. In order for an agreement with a manufacturer to be in effect under this section with respect to plan year 2026 or a subsequent plan year, the manufacturer shall enter into such agreement not later than a calendar quarter or semi-annual deadline established by the Secretary. Each manufacturer with an agreement in effect under this section shall collect and have available appropriate data, as determined by the Secretary, to ensure that it can demonstrate to the Secretary compliance with the requirements under the program. Each manufacturer with an agreement in effect under this section shall comply with requirements imposed by the Secretary, as applicable, for purposes of administering the program, including any determination under subparagraph

(A)of subsection (c)(1) or procedures established under such subsection (c)(1). An agreement under this section shall be effective for an initial period of not less than 12 months and shall be automatically renewed for a period of not less than 1 year unless terminated under subparagraph (B). The Secretary shall provide for termination of an agreement under this section for a knowing and willful violation of the requirements of the agreement or other good cause shown. Such termination shall not be effective earlier than 30 days after the date of notice to the manufacturer of such termination. The Secretary shall provide, upon request, a manufacturer with a hearing concerning such a termination, and such hearing shall take place prior to the effective date of the termination with sufficient time for such effective date to be repealed if the Secretary determines appropriate. A manufacturer may terminate an agreement under this section for any reason. Any such termination shall be effective, with respect to a plan year— if the termination occurs before January 31 of a plan year, as of the day after the end of the plan year; and if the termination occurs on or after January 31 of a plan year, as of the day after the end of the succeeding plan year. Any termination under this subparagraph shall not affect discounts for applicable drugs of the manufacturer that are due under the agreement before the effective date of its termination. An agreement under this section shall take effect at the start of a calendar quarter or another date specified by the Secretary. The duties described in this subsection are the following: Administering the program, including— the determination of the amount of the discounted price of an applicable drug of a manufacturer; the establishment of procedures to ensure that, not later than the applicable number of calendar days after the dispensing of an applicable drug by a pharmacy or mail order service, the pharmacy or mail order service is reimbursed for an amount equal to the difference between— the negotiated price of the applicable drug; and the discounted price of the applicable drug; the establishment of procedures to ensure that the discounted price for an applicable drug under this section is applied before any coverage or financial assistance under other health benefit plans or programs that provide coverage or financial assistance for the purchase or provision of prescription drug coverage on behalf of applicable beneficiaries as specified by the Secretary; and providing a reasonable dispute resolution mechanism to resolve disagreements between manufacturers, prescription drug plans and MA–PD plans, and the Secretary. The Secretary shall monitor compliance by a manufacturer with the terms of an agreement under this section. The Secretary may collect appropriate data from prescription drug plans and MA–PD plans in a timeframe that allows for discounted prices to be provided for applicable drugs under this section. Subject to paragraph (2), the Secretary shall provide for the implementation of this section, including the performance of the duties described in subsection (c). In providing for the implementation of this section, the Secretary shall not receive or distribute any funds of a manufacturer under the program. A manufacturer that fails to provide discounted prices for applicable drugs of the manufacturer dispensed to applicable beneficiaries in accordance with an agreement in effect under this section shall be subject to a civil money penalty for each such failure in an amount the Secretary determines is equal to the sum of— the amount that the manufacturer would have paid with respect to such discounts under the agreement, which will then be used to pay the discounts which the manufacturer had failed to provide; and 25 percent of such amount. The provisions of section 1128A (other than subsections

(a)and (b)) shall apply to a civil money penalty under this subsection in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a). Nothing in this section shall prevent an applicable beneficiary from purchasing a covered part D drug that is not an applicable drug (including a generic drug or a drug that is not on the formulary of the prescription drug plan or MA–PD plan that the applicable beneficiary is enrolled in). In this section: The term applicable beneficiary means an individual who, on the date of dispensing a covered part D drug— is enrolled in a prescription drug plan or an MA–PD plan; is not enrolled in a qualified retiree prescription drug plan; and has incurred costs, as determined in accordance with section 1860D–2(b)(4)(C), for covered part D drugs in the year that exceed the annual deductible specified in section 1860D–2(b)(1). The term applicable drug , with respect to an applicable beneficiary— means a covered part D drug— approved under a new drug application under section 505(c) of the Federal Food, Drug, and Cosmetic Act or, in the case of a biologic product, licensed under section 351 of the Public Health Service Act; and if the PDP sponsor of the prescription drug plan or the MA organization offering the MA–PD plan uses a formulary, which is on the formulary of the prescription drug plan or MA–PD plan that the applicable beneficiary is enrolled in; if the PDP sponsor of the prescription drug plan or the MA organization offering the MA–PD plan does not use a formulary, for which benefits are available under the prescription drug plan or MA–PD plan that the applicable beneficiary is enrolled in; or is provided through an exception or appeal; and does not include a selected drug (as referred to under section 1192(c)) during a price applicability period (as defined in section 1191(b)(2)) with respect to such drug. The term applicable number of calendar days means— with respect to claims for reimbursement submitted electronically, 14 days; and with respect to claims for reimbursement submitted otherwise, 30 days. The term discounted price means, subject to subparagraphs

(B)and (C), with respect to an applicable drug of a manufacturer dispensed during a year to an applicable beneficiary— who has not incurred costs, as determined in accordance with section 1860D–2(b)(4)(C), for covered part D drugs in the year that are equal to or exceed the annual out-of-pocket threshold specified in section 1860D–2(b)(4)(B)(i) for the year, 90 percent of the negotiated price of such drug; and who has incurred such costs, as so determined, in the year that are equal to or exceed such threshold for the year, 80 percent of the negotiated price of such drug. In the case of an applicable drug of a specified manufacturer (as defined in clause (ii)) that is marketed as of the date of enactment of this subparagraph and dispensed for an applicable beneficiary who is a subsidy eligible individual (as defined in section 1860D–14(a)(3)), the term discounted price means the specified LIS percent (as defined in clause (iii)) of the negotiated price of the applicable drug of the manufacturer. In this subparagraph, subject to subclause (II), the term specified manufacturer means a manufacturer of an applicable drug for which, in 2021— the manufacturer had a coverage gap discount agreement under section 1860D–14A; the total expenditures for all of the specified drugs of the manufacturer covered by such agreement or agreements for such year and covered under this part during such year represented less than 1.0 percent of the total expenditures under this part for all covered Part D drugs during such year; and the total expenditures for all of the specified drugs of the manufacturer that are single source drugs and biological products for which payment may be made under part B during such year represented less than 1.0 percent of the total expenditures under part B for all drugs or biological products for which payment may be made under such part during such year. For purposes of this clause, the term specified drug means, with respect to a specified manufacturer, for 2021, an applicable drug that is produced, prepared, propagated, compounded, converted, or processed by the manufacturer. All persons treated as a single employer under subsection

(a)or

(b)of section 52 of the Internal Revenue Code of 1986 shall be treated as one manufacturer for purposes of this subparagraph. For purposes of making a determination pursuant to the previous sentence, an agreement under this section shall require that a manufacturer provide and attest to such information as specified by the Secretary as necessary. The term specified manufacturer shall not include a manufacturer described in subclause

(I)if such manufacturer is acquired after 2021 by another manufacturer that is not a specified manufacturer, effective at the beginning of the plan year immediately following such acquisition or, in the case of an acquisition before 2025, effective January 1, 2025. In this subparagraph, the specified LIS percent means, with respect to a year— for an applicable drug dispensed for an applicable beneficiary described in clause

(i)who has not incurred costs, as determined in accordance with section 1860D–2(b)(4)(C), for covered part D drugs in the year that are equal to or exceed the annual out-of-pocket threshold specified in section 1860D–2(b)(4)(B)(i) for the year— for 2025, 99 percent; for 2026, 98 percent; for 2027, 95 percent; for 2028, 92 percent; and for 2029 and each subsequent year, 90 percent; and for an applicable drug dispensed for an applicable beneficiary described in clause

(i)who has incurred costs, as determined in accordance with section 1860D–2(b)(4)(C), for covered part D drugs in the year that are equal to or exceed the annual out-of-pocket threshold specified in section 1860D–2(b)(4)(B)(i) for the year— for 2025, 99 percent; for 2026, 98 percent; for 2027, 95 percent; for 2028, 92 percent; for 2029, 90 percent; for 2030, 85 percent; and for 2031 and each subsequent year, 80 percent. In the case of an applicable drug of a specified small manufacturer (as defined in clause (ii)) that is marketed as of the date of enactment of this subparagraph and dispensed for an applicable beneficiary, the term discounted price means the specified small manufacturer percent (as defined in clause (iii)) of the negotiated price of the applicable drug of the manufacturer. In this subparagraph, subject to subclause (III), the term ‘specified small manufacturer’ means a manufacturer of an applicable drug for which, in 2021— the manufacturer is a specified manufacturer (as defined in subparagraph (B)(ii)); and the total expenditures under part D for any one of the specified small manufacturer drugs of the manufacturer that are covered by the agreement or agreements under section 1860D–14A of such manufacturer for such year and covered under this part during such year are equal to or more than 80 percent of the total expenditures under this part for all specified small manufacturer drugs of the manufacturer that are covered by such agreement or agreements for such year and covered under this part during such year. For purposes of this clause, the term specified small manufacturer drugs means, with respect to a specified small manufacturer, for 2021, an applicable drug that is produced, prepared, propagated, compounded, converted, or processed by the manufacturer. All persons treated as a single employer under subsection

(a)or

(b)of section 52 of the Internal Revenue Code of 1986 shall be treated as one manufacturer for purposes of this subparagraph. For purposes of making a determination pursuant to the previous sentence, an agreement under this section shall require that a manufacturer provide and attest to such information as specified by the Secretary as necessary. The term specified small manufacturer shall not include a manufacturer described in subclause

(I)if such manufacturer is acquired after 2021 by another manufacturer that is not a specified small manufacturer, effective at the beginning of the plan year immediately following such acquisition or, in the case of an acquisition before 2025, effective January 1, 2025. In this subparagraph, the term specified small manufacturer percent means, with respect to a year— for an applicable drug dispensed for an applicable beneficiary who has not incurred costs, as determined in accordance with section 1860D–2(b)(4)(C), for covered part D drugs in the year that are equal to or exceed the annual out-of-pocket threshold specified in section 1860D–2(b)(4)(B)(i) for the year— for 2025, 99 percent; for 2026, 98 percent; for 2027, 95 percent; for 2028, 92 percent; and for 2029 and each subsequent year, 90 percent; and for an applicable drug dispensed for an applicable beneficiary who has incurred costs, as determined in accordance with section 1860D–2(b)(4)(C), for covered part D drugs in the year that are equal to or exceed the annual out-of-pocket threshold specified in section 1860D–2(b)(4)(B)(i) for the year— for 2025, 99 percent; for 2026, 98 percent; for 2027, 95 percent; for 2028, 92 percent; for 2029, 90 percent; for 2030, 85 percent; and for 2031 and each subsequent year, 80 percent. For purposes of this paragraph, the term total expenditures includes, in the case of expenditures with respect to part D, the total gross covered prescription drug costs as defined in section 1860D–15(b)(3). The term total expenditures excludes, in the case of expenditures with respect to part B, expenditures for a drug or biological that are bundled or packaged into the payment for another service. In the case where the entire amount of the negotiated price of an individual claim for an applicable drug with respect to an applicable beneficiary does not fall above the annual deductible specified in section 1860D–2(b)(1) for the year, the manufacturer of the applicable drug shall provide the discounted price under this section on only the portion of the negotiated price of the applicable drug that falls above such annual deductible. In the case where the entire amount of the negotiated price of an individual claim for an applicable drug with respect to an applicable beneficiary does not fall entirely below or entirely above the annual out-of-pocket threshold specified in section 1860D–2(b)(4)(B)(i) for the year, the manufacturer of the applicable drug shall provide the discounted price— in accordance with subparagraph (A)(i) on the portion of the negotiated price of the applicable drug that falls below such threshold; and in accordance with subparagraph (A)(ii) on the portion of such price of such drug that falls at or above such threshold. The term manufacturer means any entity which is engaged in the production, preparation, propagation, compounding, conversion, or processing of prescription drug products, either directly or indirectly by extraction from substances of natural origin, or independently by means of chemical synthesis, or by a combination of extraction and chemical synthesis. Such term does not include a wholesale distributor of drugs or a retail pharmacy licensed under State law. The term negotiated price has the meaning given such term for purposes of section 1860D–2(d)(1)(B), and, with respect to an applicable drug, such negotiated price shall include any dispensing fee and, if applicable, any vaccine administration fee for the applicable drug. The term qualified retiree prescription drug plan has the meaning given such term in section 1860D–22(a)(2). With respect to covered part D drugs that would be applicable drugs (as defined in section 1860D–14C(g)(2)) but for the application of subparagraph

(B)of such section, the Secretary shall provide a process whereby, in the case of an applicable beneficiary (as defined in section 1860D–14C(g)(1)) who, with respect to a year, is enrolled in a prescription drug plan or is enrolled in an MA–PD plan, has not incurred costs that are equal to or exceed the annual out-of-pocket threshold specified in section 1860D–2(b)(4)(B)(i), and is dispensed such a drug, the Secretary (periodically and on a timely basis) provides the PDP sponsor or the MA organization offering the plan, a subsidy with respect to such drug that is equal to 10 percent of the negotiated price (as defined in section 1860D–14C(g)(6)) of such drug. . Section 1860D–14A of the Social Security Act ( 42 U.S.C. 1395w–114a ) is amended— in subsection (a), in the first sentence, by striking The Secretary and inserting Subject to subsection (h), the Secretary ; and by adding at the end the following new subsection: The program shall not apply with respect to applicable drugs dispensed on or after January 1, 2025, and, subject to paragraph (2), agreements under this section shall be terminated as of such date. The provisions of this section (including all responsibilities and duties) shall continue to apply on and after January 1, 2025, with respect to applicable drugs dispensed prior to such date. . Section 1860D–16(b)(1) of the Social Security Act ( 42 U.S.C. 1395w–116(b)(1) ) is amended— in subparagraph (C), by striking and at the end; in subparagraph (D), by striking the period at the end and inserting ; and ; and by adding at the end the following new subparagraph: payments under section 1860D–14D (relating to selected drug subsidy payments). . Section 1860D–13 of the Social Security Act ( 42 U.S.C. 1395w–113 ) is amended— in subsection (a)— in paragraph (1)(A), by inserting or

(8)(as applicable) after paragraph

(2); in paragraph (2), in the matter preceding subparagraph (A), by striking The base and inserting Subject to paragraph (8), the base ; in paragraph (7)— in subparagraph (B)(ii), by inserting or

(8)(as applicable) after paragraph

(2); and in subparagraph (E)(i), by inserting or

(8)(as applicable) after paragraph

(2); and by adding at the end the following new paragraph: The base beneficiary premium under this paragraph for a prescription drug plan for a month in 2024 through 2029 shall be computed as follows: The base beneficiary premium for a month in 2024 shall be equal to the lesser of— the base beneficiary premium computed under paragraph

(2)for a month in 2023 increased by 6 percent; or the base beneficiary premium computed under paragraph

(2)for a month in 2024 that would have applied if this paragraph had not been enacted. The base beneficiary premium for a month in 2025 shall be equal to the lesser of— the base beneficiary premium computed under clause

(i)for a month in 2024 increased by 6 percent; or the base beneficiary premium computed under paragraph

(2)for a month in 2025 that would have applied if this paragraph had not been enacted. The base beneficiary premium for a month in 2026 shall be equal to the lesser of— the base beneficiary premium computed under clause

(ii)for a month in 2025 increased by 6 percent; or the base beneficiary premium computed under paragraph

(2)for a month in 2026 that would have applied if this paragraph had not been enacted. The base beneficiary premium for a month in 2027 shall be equal to the lesser of— the base beneficiary premium computed under clause

(iii)for a month in 2026 increased by 6 percent; or the base beneficiary premium computed under paragraph

(2)for a month in 2027 that would have applied if this paragraph had not been enacted. The base beneficiary premium for a month in 2028 shall be equal to the lesser of— the base beneficiary premium computed under clause

(iv)for a month in 2027 increased by 6 percent; or the base beneficiary premium computed under paragraph

(2)for a month in 2028 that would have applied if this paragraph had not been enacted. The base beneficiary premium for a month in 2029 shall be equal to the lesser of— the base beneficiary premium computed under clause

(v)for a month in 2028 increased by 6 percent; or the base beneficiary premium computed under paragraph

(2)for a month in 2029 that would have applied if this paragraph had not been enacted. The base beneficiary premium for a month in 2030 or a subsequent year shall be computed under paragraph

(2)without regard to this paragraph. ; and in subsection (b)(3)(A)(ii), by striking subsection (a)(2) and inserting paragraph

(2)or

(8)of subsection

(a)(as applicable) . Section 1860D–13(a) of the Social Security Act ( 42 U.S.C. 1395w–113(a) ), as amended by paragraph (1), is amended— in paragraph (3)(A), by inserting (or, for 2030 and each subsequent year, the percent specified under paragraph (9)) after 25.5 percent ; and by adding at the end the following new paragraph: Subject to subparagraph (B), for purposes of paragraph (3)(A), the percent specified under this paragraph for 2030 and each subsequent year is the percent that the Secretary determines is necessary to ensure that the base beneficiary premium computed under paragraph

(2)for a month in 2030 is equal to the lesser of— the base beneficiary premium computed under paragraph (8)(A)(vi) for a month in 2029 increased by 6 percent; or the base beneficiary premium computed under paragraph

(2)for a month in 2030 that would have applied if this paragraph had not been enacted. The percent specified under subparagraph

(A)may not be less than 20 percent. . Section 1854(b)(2)(B) of the Social Security Act 42 U.S.C. 1395w–24(b)(2)(B) ) is amended by striking section 1860D–13(a)(2) and inserting paragraph

(2)or

(8)(as applicable) of section 1860D–13(a) . Section 1860D–11(g)(6) of the Social Security Act ( 42 U.S.C. 1395w–111(g)(6) ) is amended by inserting (or, for 2030 and each subsequent year, the percent specified under section 1860D–13(a)(9)) after 25.5 percent . Section 1860D–13(a)(7)(B)(i) of the Social Security Act ( 42 U.S.C. 1395w–113(a)(7)(B)(i) ) is amended— in subclause (I), by inserting (or, for 2030 and each subsequent year, the percent specified under paragraph (9)) after 25.5 percent ; and in subclause (II), by inserting (or, for 2030 and each subsequent year, the percent specified under paragraph (9)) after 25.5 percent . Section 1860D–15(a) of the Social Security Act ( 42 U.S.C. 1395w–115(a) ) is amended— in the matter preceding paragraph (1), by inserting (or, for each of 2024 through 2029, the percent applicable as a result of the application of section 1860D–13(a)(8), or, for 2030 and each subsequent year, 100 percent minus the percent specified under section 1860D–13(a)(9)) after 74.5 percent ; and in paragraph (1)(B), by striking paragraph

(2)of section 1860D–13(a) and inserting paragraph

(2)or

(8)of section 1860D–13(a) (as applicable) . Section 1860D–2 of the Social Security Act ( 42 U.S.C. 1395w–102 ) is amended— in subsection (a)(2)(A)(i)(I), by striking , or an increase in the initial and inserting or, for a year preceding 2025, an increase in the initial ; in subsection (c)(1)(C)— in the subparagraph heading, by striking ; and at initial coverage limit by inserting for a year preceding 2025 or the annual out-of-pocket threshold specified in subsection (b)(4)(B) for the year for 2025 and each subsequent year after subsection (b)(3) for the year each place it appears; and in subsection (d)(1)(A), by striking or an initial and inserting or, for a year preceding 2025, an initial . Section 1860D–4(a)(4)(B)(i) of the Social Security Act ( 42 U.S.C. 1395w–104(a)(4)(B)(i) ) is amended by striking the initial and inserting for a year preceding 2025, the initial . Section 1860D–14(a) of the Social Security Act ( 42 U.S.C. 1395w–114(a) ) is amended— in paragraph (1)— in subparagraph (C), by striking The continuation and inserting For a year preceding 2025, the continuation ; in subparagraph (D)(iii), by striking 1860D–2(b)(4)(A)(i)(I) and inserting 1860D–2(b)(4)(A)(i)(I)(aa) ; and in subparagraph (E), by striking The elimination and inserting For a year preceding 2024, the elimination ; and in paragraph (2)(E), by striking 1860D–2(b)(4)(A)(i)(I) and inserting 1860D–2(b)(4)(A)(i)(I)(aa) . Section 1860D–21(d)(7) of the Social Security Act ( 42 U.S.C. 1395w–131(d)(7) ) is amended by striking section 1860D–2(b)(4)(B)(i) and inserting section 1860D–2(b)(4)(C)(i) . Section 1860D–22(a)(2)(A) of the Social Security Act ( 42 U.S.C. 1395w–132(a)(2)(A) ) is amended— by striking the value of any discount and inserting the following: the value of— for years prior to 2025, any discount ; in clause (i), as inserted by subparagraph

(A)of this paragraph, by striking the period at the end and inserting ; and ; and by adding at the end the following new clause: for 2025 and each subsequent year, any discount provided pursuant to section 1860D–14C. . Section 1860D–41(a)(6) of the Social Security Act ( 42 U.S.C. 1395w–151(a)(6) ) is amended— by inserting for a year before 2025 after 1860D–2(b)(3) ; and by inserting for such year before the period. Section 1860D–43 of the Social Security Act ( 42 U.S.C. 1395w–153 ) is amended— in subsection (a)— by striking paragraph

(1)and inserting the following: participate in— for 2011 through 2024, the Medicare coverage gap discount program under section 1860D–14A; and for 2025 and each subsequent year, the manufacturer discount program under section 1860D–14C; ; by striking paragraph

(2)and inserting the following: have entered into and have in effect— for 2011 through 2024, an agreement described in subsection

(b)of section 1860D–14A with the Secretary; and for 2025 and each subsequent year, an agreement described in subsection

(b)of section 1860D–14C with the Secretary; and ; and in paragraph (3), by striking such section and inserting section 1860D–14A ; and by striking subsection

(b)and inserting the following: Paragraphs (1)(A), (2)(A), and

(3)of subsection

(a)shall apply to covered part D drugs dispensed under this part on or after January 1, 2011, and before January 1, 2025, and paragraphs (1)(B) and (2)(B) of such subsection shall apply to covered part D drugs dispensed under this part on or after January 1, 2025. . Section 1927 of the Social Security Act ( 42 U.S.C. 1396r–8 ) is amended— in subsection (c)(1)(C)(i)(VI), by inserting before the period at the end the following: or under the manufacturer discount program under section 1860D–14C ; and in subsection (k)(1)(B)(i)(V), by inserting before the period at the end the following: or under section 1860D–14C . The Secretary shall implement this section, including the amendments made by this section, for 2024, 2025, and 2026 by program instruction or other forms of program guidance. In addition to amounts otherwise available, there are appropriated to the Centers for Medicare & Medicaid Services, out of any money in the Treasury not otherwise appropriated, $341,000,000 for fiscal year 2022, including $20,000,000 and $65,000,000 to carry out the provisions of, including the amendments made by, this section in fiscal years 2022 and 2023, respectively, and $32,000,000 to carry out the provisions of, including the amendments made by, this section in each of fiscal years 2024 through 2031, to remain available until expended.

Connections19 off-index

19 references not yet in our index

42 USC 1395w–102(b)
42 USC 1395w–115(b)
42 USC 1395w–101
42 USC 1395w–153
42 USC 1395w–114a
42 USC 1395w–116(b)(1)
42 USC 1395w–113
42 USC 1395w–113(a)
42 USC 1395w–24(b)(2)(B)
42 USC 1395w–111(g)(6)
42 USC 1395w–113(a)(7)(B)(i)
42 USC 1395w–115(a)
42 USC 1395w–102
42 USC 1395w–104(a)(4)(B)(i)
42 USC 1395w–114(a)
42 USC 1395w–131(d)(7)
42 USC 1395w–132(a)(2)(A)
42 USC 1395w–151(a)(6)
42 USC 1396r–8

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Sec. 11201

Medicare part D benefit redesign

Cite42 USC 1395w–102(b)

Cite42 USC 1395w–115(b)

Cite42 USC 1395w–101

Cite42 USC 1395w–153

Cite42 USC 1395w–114a

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