§1395w–151 Definitions; treatment of references to provisions in part C

Summary

Sets the words and phrases used in this part and says how some Part C rules should be read for drug plans. It lists key terms and where their meanings are found: basic prescription drug coverage (see 1395w–102(a)(3)); covered part D drug (see 1395w–102(e)); creditable prescription drug coverage (see 1395w–113(b)(4)); part D eligible individual (see 1395w–101(a)(3)(A)); fallback prescription drug plan (see 1395w–111(g)(4)); initial coverage limit (the limit in 1395w–102(b)(3) for years before 2025, or the matching limit for nonstandard plans); insurance risk (risk normally taken by state‑licensed insurers and not payment changes tied to a pharmacy’s performance measures like formulary compliance or generic substitution); MA plan (see 1395w–101(a)(3)(B)); MA–PD plan (see 1395w–101(a)(3)(C)); Medicare Prescription Drug Account (see 1395w–116(a)); PDP approved bid (see 1395w–113(a)(6)); PDP region (see 1395w–111(a)(2)); PDP sponsor (a non‑government entity certified under this part); prescription drug plan (drug coverage approved under 1395w–111(e) and offered by a PDP sponsor under a contract at 1395w–112(b)); qualified prescription drug coverage (see 1395w–102(a)(1)); standard prescription drug coverage (see 1395w–102(b)); State Pharmaceutical Assistance Program (see 1395w–133(b)); subsidy eligible individual (see 1395w–114(a)(3)(A)). When Part C rules are used for prescription drug plans, read them with substitutions: read “MA plan” as “prescription drug plan,” “MA organization” or “provider‑sponsored organization” as “PDP sponsor,” a contract under 1395w–27 as a contract under 1395w–112(b), “Part C” as this part, and an “election period” under 1395w–21 as the “enrollment period” under 1395w–101.