Title 42 — The Public Health and WelfareRelease 119-73

§1395w–114d Selected drug subsidy program

Title 42 › Chapter CHAPTER 7— - SOCIAL SECURITY › Subchapter SUBCHAPTER XVIII— - HEALTH INSURANCE FOR AGED AND DISABLED › Part Part D— - Voluntary Prescription Drug Benefit Program › Subpart subpart 2— - prescription drug plans; pdp sponsors; financing › § 1395w–114d

Last updated Apr 6, 2026|Official source

Summary

The Secretary must set up a process to pay a subsidy for certain Part D drugs. When a person in a prescription drug plan or an MA–PD plan has not yet reached the year’s out-of-pocket limit and is given one of these drugs, the Secretary must regularly pay the plan sponsor or MA organization an amount equal to 10% of the drug’s negotiated price. Applicable drug: a covered Part D drug that would qualify but for a specific exclusion. Applicable beneficiary: a person enrolled in a PDP or MA–PD who meets the rule for these drugs.

Full Legal Text

Title 42, §1395w–114d

The Public Health and Welfare — Source: USLM XML via OLRC

With respect to covered part D drugs that would be applicable drugs (as defined in section 1395w–114c(g)(2) of this title) 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 1395w–114c(g)(1) of this title) 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 1395w–102(b)(4)(B)(i) of this title, 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 1395w–114c(g)(6) of this title) of such drug.

Reference

Citations & Metadata

Citation

42 U.S.C. § 1395w–114d

Title 42 — The Public Health and Welfare

Last Updated

Apr 6, 2026

Release point: 119-73